Dyslipidemia is traditionally considered a weaker contributor to stroke risk than hypertension or diabetes. However, its relationship with intracranial major artery stenosis (ICAS) may be particularly relevant in Asian populations. This prospective longitudinal study published in Atherosclerosis assessed the association of familial hypercholesterolemia (FH) with ICAS and symptomatic ischemic stroke in Japan.

This prospective longitudinal study included 150 patients with FH who attended a lipid clinic and underwent brain magnetic resonance imaging (MRI) at the National Cerebral and Cardiovascular Center, and 3,178 individuals undergoing MRI through the Brain Dock screening program. FH status and ICAS (≥50% stenosis) were evaluated. Associations were assessed using multivariable models.

FH was independently associated with a higher prevalence of ICAS (adjusted odds ratio: 17.82; 95% confidence interval [CI]: 8.74-36.36). FH was also associated with a higher incidence of symptomatic ischemic stroke (adjusted hazard ratio [aHR]: 5.83; 95% CI: 2.03-16.77). Among patients with FH, the presence of ICAS was significantly associated with symptomatic ischemic stroke (aHR: 7.73; 95% CI: 1.53-39.06).

In this Japanese cohort, FH was associated with both intracranial arterial changes and increased stroke risk. These findings suggest that genetic and ethnic factors may warrant consideration in stroke risk assessment.