Inverse Association between High-Density Lipoprotein Cholesterol and Adverse Outcomes among Acute Ischemic Stroke Patients with Diabetes Mellitus

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.

Monocyte to high‐density lipoprotein ratio predicts clinical outcomes after acute ischemic stroke or transient ischemic attack

“… 38 Another study enrolled AIS patients with diabetes reported that HDL levels were negatively correlated with the risk of recurrent stroke and major adverse cardiovascular events within 1 year. 39 HDL has also been found to be an independent risk factor for 3‐month poor outcomes in patients with ischemic stroke. 40 This may be related to the fact that HDL can prevent monocytes from recruiting to the arterial wall, thereby inhibiting the adhesion of monocytes to endothelial cells, reducing the activation of monocytes and the proliferation of monocyte progenitor cells, 41 thereby protecting endothelial cells from inflammation and oxidative stress.…”

“…A prospective cohort study found that changes in HDL proteins during the early acute phase of stroke was associated with recovery 38 . Another study enrolled AIS patients with diabetes reported that HDL levels were negatively correlated with the risk of recurrent stroke and major adverse cardiovascular events within 1 year 39 . HDL has also been found to be an independent risk factor for 3‐month poor outcomes in patients with ischemic stroke 40 .…”