Association Of Elevated High-Density Lipoprotein Cholesterol Levels With The Outcomes Of Patients With Small-Artery Occlusion

Objective:Although numerous studies have shown that dyslipidemia and stroke are related,the relationship between high-density lipoprotein cholesterol(HDL-C)and smallartery occlusion(SAO),a subtype of ischemic stroke,is not well understood.The aim of this study was to investigate the association between HDL levels and SAO prognoses.Materials and Methods:A total of 17980 consecutive patients with ischemic stroke were recruited from Tianjin Huanhu Hospital between January 01,2008,and December 31,2015.3067 patients with small-artery occlusion were elected according to the Trial of Org 10172 in Acute Stroke Treatment(TOAST)classification.The clinical data of SAO patients were retrospectively analyzed,including age,sex,hypertension,diabetes,smoking,drinking,obesity,the United States National Institutes of Health Stroke Scale score(NIHSS)and serum total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C)collected within 24 hours of admission.HDL-C values at admission were classified into four groups according to quartiles(<0.92,0.92–1.08,1.08–1.28,and ?1.28).We divided patients into three groups according to age(<45 years,?45 and <75 years,?75 years).The primary outcomes inclueded prognoses of patients with SAO(favorable or poor prognoses)during a 12-month period after stroke onset.And the modified Rankin scale(mRS)was used to evaluate functional outcomes.NIHSS scores ranged from 0 to 14.Stroke severity was assessed using the NIHSS.Age,sex,hypertension,diabetes,smoking,alcoholism,obesity,and NIHSS scores were confounding factors.In univariate analysis,the differences of each factor between the different prognosis groups were compared.The confound factors with statistical difference(P<0.05)were selected for Logistic regression analysis to correct the correlation between HDL and mRS.Statistical analyses were performed using the Statistical Package SPSS 24.0.Results: 1.In the baseline analysis,there was a statistically significant association between HDL-C level and age and diabetes(P < 0.05).Patients with high levels of HDL-C may be more likely to be older and less likely to develop diabetes.However,further analysis showed that there was no statistically significant difference between the prognosis of patients with diabetes and small-artery occlusive stroke(P >0.05).2.Of 3067 patients,the prognosis was good in 2284 patients(74.5%)and poor in 222 patients(7.2%),783(25.5%)had a composite of poor outcomes,recurrent stroke,myocardial infarction(MI)or vascular death within 12 months.After multiple logistic regression analysis,it was found that among primary outcome,HDL-C levels in the two higher quartiles(1.08 – 1.28 mmol/L and ? 1.28 mmol/L)were positively correlated with the 12-month primary outcome of patients with SAO(1.08–1.28 mmol/L,0.587;95% CI,0.394-0.873;P = 0.009;?1.28 mmol/L,0.448;95% CI,0.291-0.688;P < 0.001).A direct correlation was found in patients aged 45–75 years(1.08–1.28 mmol/L,P = 0.033;?1.28 mmol/L,P = 0.001).However,no association was found between outcomes and lower HDL levels(0.92–1.08 mmol/L,P = 0.079).3.Similar to the primary outcome,the two higher levels of high density lipoprotein cholesterol were independently associated with poor prognosis,stroke recurrence,myocardial infarction,and vascular death in the SAO patients after 12 months(P<0.05).A direct positive correlation was also found between the highest HDL-C and SAO patients aged 45–75 years with a 12-month secondary outcomes(?1.28 mmol/L,P = 0.007).Conclusion:An elevated HDL cholesterol level in patients with SAO is an independent predictor of a favorable prognosis 12 months after SAO.However,the association was only present in patients aged 45–75 years.