Association between high-density lipoprotein cholesterol to apolipoprotein A-1 ratio and the outcome of ischemic stroke: a retrospective study

High-density lipoprotein cholesterol (HDL-C)/apolipoprotein A-1 (APOA-1) ratio has been identified as a risk factor for cardiovascular disease, cancer, and all-cause mortality. However, data related to ischemic stroke (IS) are lacking. We investigated whether the HDL-C/APOA-1 ratio was associated with 3-month functional outcome in patients with IS. A retrospective analysis was performed on 674 patients with IS. The 3-month functional outcome was classified as good or poor based on the modified Rankin Scale score (mRS). Logistic regression models (unadjusted and stepwise) were performed to evaluate the correlation between HDL-C/APOA-1 ratio and outcome. Restricted cubic splines evaluated nonlinear relationships, while subgroup analyses explored effect modifications. We assessed the added predictive value of the HDL-C/APOA-1 ratio by comparing nested models using the AUC, NRI, and IDI. The HDL-C/APOA-1 level in the group with poor functional outcomes was higher than that in the group with good functional outcomes (0.99 ± 0.14 vs. 0.94 ± 0.10, p < 0.001). In the multivariable analysis, a higher HDL-C/APOA-1 ratio was identified as an independent factor associated with poor outcome at 3 months (OR 1.50, 95% CI:1.17–1.96, p = 0.003). The odds of poor outcome in the higher HDL-C/APOA-1 quartile increased by 2.44-fold (95% CI:1.30–4.64, p = 0.006) after adjusting for potential confounders compared to lower HDL-C/APOA-1 quartiles. In addition, multivariate-adjusted restricted cubic splines show a positive approach linear pattern of this association. Elevated HDL-C/APOA-1 is independently associated with an increased risk of poor functional outcomes at 3-month in patients with IS.