Apolipoprotein A-I and B and stroke events in a community-based cohort in Taiwan: Report of the Chin-Shan Community Cardiovascular Study

There are limited prospective cohort studies of the well-known association between stroke events and serum lipids for the Taiwanese population, in whom stroke is the second most common cause of death. This report describes the effect of dyslipidemia on the risk of stroke in a community-based cohort consisting of 3602 adults aged > or =35 years, established in 1990 in the Chin-Shan community in Taipei County, Taiwan. As of the end of 1998, 97 stroke incidence cases were identified from medical records and death certificates (53 in men and 44 in women). The female-to-male stroke event rates increased from 0.42 in the youngest group (aged 35 to 44 years) to 1.38 in the oldest (aged > or =75 years). Multiple Cox proportional hazard regression models controlling for age and sex revealed that individuals with serum apolipoprotein A-I (apoA-I) at the highest quartile were more likely to have a stroke event than those at the lowest quartile level (relative risk [RR]=2.02, P for trend=0.010). The corresponding risk of stroke predicted by apolipoprotein B (apoB) was also significant (RR=1.88, P for trend=0.020). After adjustment for age, sex, hypertension, and diabetes status, the interaction between hypertension and apoA-I level remained significant in predicting stroke events in men but not in women (RR=1.71, P=0.033 in men; RR=2.29, P=0.071 in women). We conclude that apoA-I but not apoB levels may serve as an effect modifier of hypertension for the risk of stroke events.