Abstract 17611: Acute Ischemic Stroke in Patients With LDL Less Than 70, What Next? Potential Role of TG/HDL Ratio for Treatment Optimization and Risk Stratification

Abstract

Introduction: There are no established guidelines stratifying risk factors for patients who develop ischemic stroke after goal LDL is achieved. The effect of TG-HDL ratio on cerebrovascular accidents is still being studied. We aim to study the impact of TG-HDL ratio on the outcome of the patients with stroke and LDL less than 70 mg/dl and to determine if it can be used to prognosticate the cardiovascular/cerebrovascular outcome among these patients. Methods: This is a single center prospective observational study including patients admitted between January 2021 and March 2023 with stroke and LDL less than 70 mg/dl. Baseline data was collected by chart review. Patients were followed up at 6-month intervals. Logistic regression was used to determine which factors influenced mortality outcomes. Results: Among 801 patients admitted for acute stroke during the study period, 153 (22%) had an ischemic event and baseline LDL less than 70. Mean age was 68 SD13 .Total number of patients with TG:HDL ratio >2 was 91 vs 60 patients with ratio <2. The use of statins was comparable in both groups 58% vs 57% respectively. In patients with TG:HDL ratio >2, prevalence of DM was significantly higher than patients with ratio <2 (72% vs 41%). Mean NIHSS among patients with TG:HDL ratio >2 was 6.82 vs 5.95 in patients with ratio <2 (p=0.1). Mortality among patients with ratio >2 was 4.4% vs 17% in patients with ratio <2 (p=0.01) but when logistic regression was performed to control for confounders such as BMI, Age, sex, SBP on admission, statin use and comorbidities including CAD, CHF, A.fib and substance use. Patients with TG/HDL>2 had a higher risk of mortality (OR 7.3 IC95% 1.4-36.5, p=0.015). Total number of patients on follow up at 6 months were 32. Mortality at 6 months follow up was comparable between patient with TG:HDL ratio <2 and >2 (11.1% vs 14.3%, p=0.78). Conclusions: There is a potential role for TG-HDL ratio in determining cardio/cerebrovascular outcomes among patients who develop stroke with target LDL of ≤ 70 mgs/dl. Larger studies are needed to evaluate the role of the TG-HDL ratio as a biomarker to optimize risk stratification and improving outcomes in this population.