Association Between High‐Density Lipoprotein Cholesterol Levels and Prognoses in Patients With Stroke

Background We aimed to evaluate the prognostic effect of serum high‐density lipoprotein cholesterol (HDL‐c) concentration on the risk of vascular events and functional prognosis in patients with stroke. Methods In this prospective observational study, patients with ischemic stroke were consecutively enrolled within 1 week of symptom onset and followed up for 1 year. Patients were divided into 3 groups according to tertiles of serum HDL‐c levels (tertile 1, 60 mg/dL). The primary outcome was a composite of major adverse cardiovascular events, including nonfatal stroke, nonfatal acute coronary syndrome, major peripheral artery disease, and vascular death. The secondary outcome was the modified Rankin scale score. Results A total of 865 patients (mean age, 70.2 years; male, 61.1%) were included. High HDL‐c levels were associated with older age, female sex, low body mass index, nonsmoking, and low prevalences of diabetes and coronary artery disease. No significant differences were found in the risk of major adverse cardiovascular events between the 3 groups (annual rates: 17.5%, 11.2%, and 12.4% in tertiles 1, 2, and 3, respectively; log‐rank P =0.11). However, significant differences were observed in the modified Rankin scale scores at 3 months and 1 year between these groups. After multivariable adjustments, higher HDL‐c levels comparing tertile 3 with tertile 1 were independently associated with good functional outcomes (modified Rankin scale score of 0–2) at 3 months (adjusted odds ratio [OR], 1.71 [95% CI, 1.03–2.83]) and 1 year (adjusted OR, 1.60 [95% CI, 1.00–2.57]), respectively. Conclusions No correlations were observed between HDL‐c levels and vascular event risk; however, elevated HDL‐c concentrations were associated with favorable functional recovery in patients with stroke. Registration https://upload.umin.ac.jp ; Unique Identifier: UMIN000031913