Table 1.

Summary of the included studies showing no relation between lipid and MI and stroke.

Author, Year	Name of the Study	Participants	Number of Risk Factors	Findings
Jia Zheng, Zhaoqing Sun, Xingang Zhang, Zhao Li, Xiaofan Guo, Yanxia Xie, Yingxian Sun & Liqiang Zheng, 2019	Non-traditional lipid profiles associated with ischemic stroke not hemorrhagic stroke in hypertensive patients: Results from an 8.4 years follow-up study	5099 hypertensive patients, aged 35 or older and without cardiovascular disease, were selected for the prospective cohort study.	Age, sex, ethnicity, BMI, current smoking, current drinking, diabetes mellitus, SBP, DBP, and anti-hypertensive medications	The study concluded that HDL had no association with ischemic stroke and all lipid parameters were not associated with hemorrhagic stroke incidence. In addition to this, LDL/HDL was the best predictor of IS; hence it may help improve the efficacy of the individualized patient stroke risk assessment, diagnosis, and guide clinical decisions.
Hindy, G., Engström, G., Larsson, S. C., Traylor, M., Markus, H. S., Melander, O., & Orho-Melander, M. (2018)	Role of Blood Lipids in the Development of Ischemic Stroke and its Subtypes Mendelian randomization (MR)	185 genome-wide lipids- SNPs	High LDL, High Triglyceride, Low HDL	LDL cholesterol lowering is likely to prevent large artery atherosclerosis but may not prevent small artery occlusion nor cardioembolic strokes. High-density lipoprotein cholesterol elevation may lead to benefits in small artery disease prevention. Finally, triglyceride-lowering may not yield benefits in ischemic stroke and its subtypes.
Mukesh Gupta (2018)	Assessment of Lipid Profile of Patients with Acute Myocardial Infarction: A Comparative Study	20 AMI patients and 20 normal	Patients with acute myocardial infarction and who gave written consent for participating in the study. 2. Chest pain lasting more than 20 minutes 3. Diagnostic ECG changes with characteristic ECG alterations consisting of (in Absence of LVH and LBBB) a. ST-elevation: i. New ST elevation at J point in two contiguous leads with the cut-points. ii. ≥0.1mV in all leads other than leads V2–V3 where the following cut points apply. ≥0.2 mV in men ≥40 years; ≥0.25 mV in men	Risk of AMI is not prevented by a reduction in the mean serum cholesterol levels.
Ravnskov, U., Diamond, D. M., Hama, R., Hamazaki, T., Hammarskjöld, B., Hynes, N., ... & McCully, K. S. (2016)	Lack of association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: A systematic review	68094 elderly people	Low-density lipoprotein cholesterol (LDL-C) as a risk factor for mortality in elderly people	High LDL-C is inversely associated with mortality in most people over 60 years of age. This study provides the rationale for a re-evaluation of guidelines recommending pharmacological reduction of LDL-C in the elderly as a component of cardiovascular disease prevention strategies.
Domma, A. M., & Gamal, M. A. (2015)	Association between Acute Myocardial Infarction, Lipid Profile and Smoking Habit	125 males and 49 females their ages ranged from 30-90 years old.	Smoking, increased total blood cholesterol and triglycerides concentration.	No clear evidence that increased total blood cholesterol and triglycerides concentration play an important role in the development of myocardial infarction in those patients included in this study.
Philip-Ephraim, E. E., Charidimou, A., & Kajogbola, G. A. (2015)	Quadriparesis due to simultaneous occurrence of hemorrhagic and ischemic stroke	100 patients with an age range of 32 to 88 years.	There were 100 patients, comprising 50 acute ischemic stroke patients and 50 non-stroke patients (controls) who had diseases other than stroke, including peptic ulcer disease, bronchial asthma, uncontrolled hypertension, and diabetes mellitus.	The predictive role of lipid profile as a stroke risk factor remains controversial as our study failed to demonstrate the association between lipid profile and stroke.
Lauren C Blekkenhorst Richard L Prince Jonathan M Hodgson Wai H Lim Kun ZhuAmanda Devine Peter L Thompson Joshua R Lewis (2015)	Dietary saturated fat intake and atherosclerotic vascular disease mortality in older women: A prospective cohort study	1469 women with a mean ± SD age of 75.2 ± 2.7 y	Outcome data were serum lipids at baseline and ASVD deaths over 10 y (13,649 person-years of follow-up). Other risk factors for ASVD were assessed and adjusted for in multivariable analyses.	LDL cholesterol was not associated with ASVD mortality in this cohort.
Bianca Nogrady Medicine Today (2015)	Does lipid-lowering reduce stroke risk in the elderly? The nine-year French observational study.	7484 men and women, with a mean age of 73.9 years	Age, sex, body mass index, hypertension, systolic blood pressure, and high lipid.	The study found no association between lipid lowering drug use and reductions in the risk of coronary heart disease, even after accounting for age, sex, body mass index, hypertension, systolic blood pressure, and other factors. Commenting on the study, Professor Mark Nelson said that although the finding was interesting, the lack of effect of lipid lowering on coronary artery disease suggested the outcomes were compromised by treatment allocation bias.
Lise Bathum, René Depont Christensen, Lars Engers Pedersen, Palle Lyngsie Pedersen, John Larsen &Jørgen Nexøe (2013)	Association of lipoprotein levels with mortality in subjects aged 50 + without previous diabetes or cardiovascular disease: A population-based register study	118160 subjects aged 50 +	Compared with subjects with TC < 5 mmol/L, adjusted hazard ratios for the group aged 60–70 years ranged from 0.68 (95% confidence interval (CI) 0.61–0.77) for TC 5–5.99 mmol/L to 0.67 (95% CI 0.59–0.75) for TC 6–7.99 mmol/L and 1.02 (95% CI 0.68–1.53) for TC ≥ 8 mmol/L in males and from 0.57 (95% CI 0.48–0.67) to 0.59 (95% CI 0.50–0.68) and 1.02 (95% CI: 0.77–1.37) in females.	These associations indicate that high lipoprotein levels do not seem to be harmful in the general population.
Khan, H. A., Alhomida, A. S., & Sobki, S. H. (2013)	Lipid profile of patients with acute myocardial infarction and its correlation with systemic inflammation.	67 AMI patients and 25 patients with chest pain	ST-elevated myocardial infarction, non-ST-elevated myocardial infarction, chest pain.	The findings suggest that reduction in serum cholesterol does not prevent the risk of AMI.
Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine (SEARCH) Collaborative Group, 2010	Intensive lowering of LDL cholesterol with 80 mg versus 20 mg simvastatin daily in 12,064 survivors of myocardial infarction: A double-blind randomised trial.	12,064 men and women aged 18–80 years with a history of myocardial infarction.	Men and women aged 18–80 years with a history of previous myocardial infarction were eligible provided they match the following inclusion criteria: either current statin use or clear indication for this treatment (and no clear indication for folic acid); total cholesterol of at least 3·5 mmol/L if already on a statin or 4·5 mmol/L if not; and no clear contraindications to the study treatments.11 Individuals with other predominant medical problems that could reduce compliance with long-term study treatment were also excluded.	Participants assigned to 80mg simvastatin vs. 20 mg results showed no apparent differences in numbers of hemorrhagic strokes or deaths attributed to vascular or non- causes despite the reduction in LDL.
Willey, J. Z., Xu, Q., Boden-Albala, B., Paik, M. C., Moon, Y. P., Sacco, R. L., & Elkind, M. S. (2009)	Lipid Profile Components and Risk of Ischemic Stroke The Northern Manhattan Study (NOMAS) Population-based prospective cohort study.	2940 patients	Stroke-free community residents.	Baseline lipid panel components were not associated with increased stroke risk in this cohort.
Prospective Studies Collaboration, 1995.	Cholesterol, diastolic blood pressure, and stroke: 13,000 strokes in 450,000 people in 45 prospective cohorts	450,000 individuals	Sex, diastolic blood pressure, history of coronary disease, or ethnicity (Asian or non-Asian).	Did not find an association between total cholesterol levels and stroke after standardization forage except, perhaps, in those under 45 years of age when screened.