Abstract DP060: Association Between Lifetime Lipid Trajectories and Stroke Prevalence in the Framingham Heart Study

Introduction: Higher levels of low-density lipoprotein (LDL), total cholesterol (TC) and triglycerides (TRIG) and lower levels of high-density lipoprotein (HDL), have been linked to increased risk of cardiovascular diseases. However, the impact of long-term patterns of lipid level trajectories on these diseases over the lifetime has been understudied. The aim of this work was to study the association between lifetime lipid trajectories and stroke prevalence among participants in the Framingham Heart Study. Methods: Lipid measurements were obtained from participants in the FHS original cohort between 1948-2005 in 32 exams and offspring cohort between 1971 to 2016 in 9 exams of the Framingham Heart Study. Functional principal component analysis (FPCA) was applied to model trajectories of the four lipid measures separately, followed with k-means clustering of the FPCA scores of major variations. Association between lipid trajectory clusters and stroke event was examined using three logistic regression models: Model 1 adjusted for age, sex and cohort; Model 2 further adjusted for baseline hypertension, smoking, and diabetes; and Model 3 additionally adjusted for lipid treatment duration based on Model 2. Results: Among 7580 participants (46% male, mean age at baseline 38 years, 1433 stroke cases), three distinct trajectory clusters were identified for HDL (n=3840) , LDL (n=3326), and TC (n=7580), and four clusters for TRIG (n=3472). In general, group 1 represented the lowest-risk trajectory and was used as the reference group in all analyses. All lipid trajectories were significantly associated with stroke, with similar results across the three models. For example, in Model 1 and compared with group 1, group 3 of HDL was associated with higher risk of stroke with adjusted odds ratio (aOR) of 1.68 (95% CI: 1.26–2.25); group2 of TC trajectory was associated with a higher risk of stroke (aOR=1.23, 95% CI: 1.06–1.42). In Model 3, only group 3 and 4 of TRIG trajectory were significantly associated with stroke, with an aOR of 1.74 (95% CI: 1.22–2.45) and an aOR of 2.03 (95% CI: 1.37–2.99). Conclusion: Lifetime LDL, TC, and TRIG trajectories clusters characterized by higher lipid levels across time were generally associated with increased stroke risk, whereas HDL clusters with higher levels were associated with lower stroke risk.