Meschia et al Guidelines for the Primary Prevention of Stroke 3761 Dyslipidemia Total Cholesterol Most studies have found high total cholesterol to be a risk factor for ischemic stroke. In the Multiple Risk Factor Intervention Trial (MRFIT), comprising >350 000 men, the RR of death resulting from nonhemorrhagic stroke increased progressively with each higher level of cholesterol.129 In the Alpha-Tocopherol Beta-Carotene Cancer Prevention (ATBC) study, which included >28 000 cigarette-smoking men, the risk of cerebral infarction was increased among those with total cholesterol levels of 7 mmol/L ( 271 mg/ In the Asia Pacific Cohort Studies Collaboration (APCSC), which included 352 033 individuals, there was a 25% (95% CI, 13 40) increase in ischemic stroke rates for every 1-mmol/L (38.7-mg/dL) increase in total choles- In the Women s Pooling Project, which included 24 343 US women <55 years of age with no previous CVD, and in the Women s Health Study (WHS), a prospective cohort study of 27 937 US women 45 years of age, higher cholesterol levels were also associated with increased risk of ischemic stroke.132,133 In other studies, the association between cholesterol and stroke was less clear. In the ARIC study, including 14 175 middle-aged men and women free of clinical CVD, the relationships between lipid values and incident ischemic stroke were weak.134 Most studies have found an inverse relationship between cholesterol levels and risk of hemorrhagic stroke. 