Association of lipoprotein indices with 3-month functional outcome after ischemic stroke: a retrospective cohort study

BackgroundLipid-related parameters have been linked to vascular risk, yet their association with post-stroke functional recovery remains uncertain. We aimed to examine whether lipoprotein imbalance is associated with 3-month functional outcome after acute ischemic stroke.MethodsIn this retrospective cohort study, 748 patients with acute ischemic stroke were included. Poor functional outcome was defined as modified Rankin Scale (mRS) > 2 at 3 months. Fourteen lipid-related parameters were analyzed. Multivariable logistic regression, generalized additive models, two-piecewise regression, and subgroup analyses were performed with adjustment for age, sex, smoking, hypertension, diabetes, atrial fibrillation (AF), Trial of Org 10,172 in Acute Stroke Treatment (TOAST) classification, and baseline National Institutes of Health Stroke Scale (NIHSS) score.ResultsLDL-related measures were independently associated with poor functional outcome. Specifically, each unit increase in lbLDL-C/HDL-C (OR 1.86, 95% CI 1.32–2.63, p < 0.001) and TC/HDL-C (OR 1.27, 95% CI 1.02–1.57, p = 0.031) was linked to higher risk of poor functional outcome. Compared with the lowest quartile, patients in the highest quartile of lbLDL-C/HDL-C (OR 3.10, 95% CI 1.60–6.01, p < 0.001) and LDL-C/HDL-C (OR 2.85, 95% CI 1.43–5.67, p = 0.003) showed the strongest associations. Most LDL-related indices including NHHR, TC, and lbLDL-C showed positive associations (all p < 0.05), whereas TG and TG/HDL-C displayed decreasing trends. Exploratory smooth-curve and threshold analyses suggested non-linear patterns for HDL-C and remnant cholesterol, although remnant cholesterol was not independently associated with functional outcome in the primary adjusted analyses. AF significantly modified the associations of lipid ratios with outcome, with stronger associations observed among patients without AF.ConclusionLipoprotein imbalance, reflected by LDL-related ratios, was associated with 3-month functional outcome after ischemic stroke. The observed non-linear patterns and interaction with AF suggest heterogeneity in lipid-outcome associations after ischemic stroke. These exploratory findings require further validation in independent cohorts.