In MRFIT, the risk of death resulting from ICH was increased 3-fold in men with total cholesterol concentrations <4.14 mmol/L (160 mg/dL) compared with higher levels.129 In a pooled cohort analysis of the ARIC study and the Cardiovascular Health Study (CHS), lower levels of low-density lipopro- tein (LDL) cholesterol were inversely associated with incident intracranial hemorrhage.135 In the APCSC, there was a 20% (95% CI, 8 30) decreased risk of hemorrhagic stroke for every 1-mmol/L (38.7-mg/dL) increase in total Similar findings were reported in the Ibaraki Prefectural Health Study, in which the age- and sex-adjusted risk of death from parenchymal hemorrhagic stroke in peo- ple with LDL cholesterol of 140 mg/dL was about half of that in people with LDL cholesterol <80 mg/dL (OR, 0.45; The Kaiser Permanente Medical Care Program reported that serum cholesterol <178 mg/dL increased the risk of ICH among men 65 years (RR, 2.7; In a Japanese nested case-control study, patients with intraparenchymal hemorrhage had lower cho- lesterol levels than control subjects.138 In contrast, in the Korean Medical Insurance Corporation Study of 115 000 men, low serum cholesterol was not an independent risk factor for ICH.139 Overall, epidemiological studies sug- gest competing stroke risk related to total cholesterol lev- els in the general population: low levels of total cholesterol increasing risk of ICH and high levels of total cholesterol increasing risk of ischemic stroke. Given the complex relationship between total choles- terol and stroke, it is noteworthy that there appears to be no positive association between total cholesterol and stroke HDL Cholesterol Some epidemiological studies have shown an inverse rela- tionship between HDL cholesterol and risk of stroke,141 145 whereas others have not.134 The Emerging Risk Factors Collaboration performed a meta-analysis involving individual records on 302430 people without vascular disease from 68 long-term prospective studies.146 Collectively, there were 2.79 million person-years of follow-up. 