Abstract
A low high-density lipoprotein cholesterol (HDL-C) level is an identified risk factor for cardiovascular diseases. However, results on the association between HDL-C levels and adverse outcomes in diabetic status still remain limited and controversial. Herein, we evaluated the association between HDL-C levels and adverse outcomes among acute ischemic stroke (AIS) patients with diabetes mellitus. The cohort comprised 3824 AIS patients with diabetes mellitus (62.7 ± 10.5 years; 34.2% women) from the Third China National Stroke Registry (n = 15,166). Patients were classified into five groups by quintiles of HDL-C. The outcomes included recurrent stroke and major adverse cardiovascular events (MACEs) within 1 year. The relationship between HDL-C levels and the risk of adverse outcomes was analyzed by Cox proportional hazards models. Patients in the lowest quintile of HDL-C had a higher risk of recurrent stroke (hazard ratio (HR) 1.59, 95% confidence interval (CI), 1.12–2.25) and MACEs (HR 1.53, 95% CI, 1.09–2.15) during 1-year follow-up compared with those in the highest quintile of HDL-C. There were linear associations between HDL-C levels and the risks of both recurrent stroke and MACEs. Low HDL-C levels were associated with higher risks of recurrent stroke and MACEs within 1 year in AIS patients with diabetes mellitus.
Highlights
A low high-density lipoprotein cholesterol (HDL-C) level is an identified risk factor for cardiovascular diseases (CVDs) [1]
We focused on patients with ischemic stroke and diabetes mellitus in the pre-specified biomarker substudy of the CNSR-III
We found that HDL-C levels were inversely associated with the presentstroke study, and we found that levels were ischemic inversely stroke associated withwith the risksInofthe recurrent
Summary
A low high-density lipoprotein cholesterol (HDL-C) level is an identified risk factor for cardiovascular diseases (CVDs) [1]. Previous studies have found a strong inverse association between HDL-C levels and worse outcomes in the general population [1,2,3]. Experimental studies report that HDL-C plays an important role in preventing atherosclerosis due to its effect of reverse cholesterol transport (RCT), antioxidant, anti-inflammatory, anticoagulant, antiapoptotic, and vasodilatory activities, and role in endothelial function improvement [4,5,6]. Previous findings regarding the association between HDL-C levels and adverse outcomes in the diabetic status remain limited and controversial [2,3,8,10,11,12,13]. A recent prospective community-based study showed a dose–response association between high HDL-C concentrations and high CVD risk in participants with diabetes mellitus [8], while other studies
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