Cholesterol and the cerebral circulation

In contrast to ischemic heart diseases, the relationship between serum cholesterol and cerebrovascular diseases has been equivocal. This contradiction is due to the heterogeneous nature of strokes, therefore the lipid-–stroke relationship should be analyzed considering subtypes of cerebrovascular diseases. Focusing mostly on the results of research in humans, we summarize the current view on the relationship between serum cholesterol and cerebrovascular diseases. In this review, we give an overview on epidemiological data, diagnostic methods and results of some clinical therapeutic trials. We focus on the role of cholesterol in large-vessel (carotid) atherosclerosis, small-vessel cerebral diseases (lacunar infarcts, leukoaraiosis and cerebral microbleeds) and on the effects of cholesterol on the microvascular system, evaluated by studies on cerebrovascular reactivity. We also enlist new diagnostic and therapeutic approaches that may have a role in the management of patients with atherosclerotic cerebrovascular diseases in the future.