Abstract W MP67: Non-traditional Serum Lipid Indices and Recurrent Stroke Risk

Abstract

Background: Expert consensus guidelines recommend low-density lipoprotein (LDL) cholesterol as the primary serum lipid target for recurrent stroke risk reduction. Indeed, emerging evidence suggests that non-traditional serum lipid indices may be better predictors of vascular risk than LDL. Triglycerides (TG)/high-density lipoprotein (HDL) is a powerful independent predictor of all-cause mortality and cardiovascular events. Furthermore, total cholesterol (TC)/HDL ratio, LDL/HDL and non-HDL have all been independently linked with greater coronary heart disease (CHD) risk. Little is known about the effects non-traditional serum lipid indices on recurrent vascular risk after a recent stroke. Method: We analyzed the Vitamin Intervention for Stroke Prevention study database comprising 3680 recent (<120 days) ischemic stroke patients followed up for 2 years. Independent associations of each 4 lipid index (TG/HDL, TC/HDL, LDL/HDL, and non-HDL) with recurrent stroke (primary outcome) and stroke/coronary heart disease (CHD)/vascular death (secondary outcome) were analyzed. Each of the 4 groups was stratified into quintiles according to the distribution of lipid indices. Results: Of all indices evaluated only TG/HDL was consistently and independently related to both outcomes: compared with the lowest quintile (≤1.93), the highest TG/HDL quintile (≥6.22) was associated with stroke [adjusted hazard ratio (AHR), 1.56; 95% CI, 1.05–2.32] and stroke/CHD/vascular death (AHR 1.39, 95% CI, 1.05–1.83), including adjustment for lipid modifier use. Compared with the lowest quintile (≤3.50), the highest TC/HDL quintile (≥5.98) was associated with stroke/CHD/vascular death (AHR 1.44, 95% CI, 1.03–2.01). LDL/HDL, non-HDL, elevated TG alone, and low HDL alone, were not independently linked to either outcome. Conclusions: Of various non-traditional serum lipid indices, elevated baseline TG/HDL and TC/HDL predict future vascular risk after a stroke, but only elevated TG/HDL is related to risk of recurrent stroke. Future studies should assess the role of TG/HDL as a potential therapeutic target for global vascular risk reduction after stroke.