Reduction in the Ratio of Low-density Lipoprotein Cholesterol to Highdensity Lipoprotein Cholesterol is Associated with Increased Risks of Hemorrhagic Transformation in Patients with Acute Ischemic Stroke

Traditional and Non-Traditional Lipid Parameters in Relation to Parenchymal Hemorrhage Following Endovascular Treatment for Acute Ischemic Stroke in Anterior Circulation

Purpose

Lipid-lowering therapy is integral in acute ischemic stroke (AIS), yet the connection between lipid parameters and parenchymal hemorrhage (PH) after endovascular treatment (EVT) for AIS is not well-defined. This research aims to assess the association between various lipid parameters and the PH risk following EVT.

Patients and Methods

We examined a database of patients who underwent EVT for AIS between September 2021 and May 2023 retrospectively. Traditional and non-traditional lipid parameters were documented. PH was identified on dual energy computed tomography images within 48 h. We employed logistic regression analysis and restricted cubic splines to examine the association between various lipid parameters and the risk of PH. The predictive capacity of the lipid parameters for PH was evaluated by comparing the area under the curve.

Results

The study included 384 patients, 65 of whom (17.7%) developed PH. After adjusting for potential confounders, only triglyceride was associated with PH among the traditional lipid parameters, while all non-traditional lipid parameters were related to PH. Based on ROC curve, the ratio of remnant cholesterol to high-density lipoprotein cholesterol (RC/HDL-C) exhibited the highest predictive capability for PH. Furthermore, our analysis revealed a significant nonlinear correlation between triglyceride, non-high-density lipoprotein cholesterol, RC, RC/HDL-C and PH risk.

Conclusion

In assessing the risk of PH after EVT, non-traditional lipid parameters are often superior to traditional lipid parameters. It is recommended that routine evaluation of non-traditional lipid parameters could also be conducted in clinical practice as well.

Low MHR Is Associated with Hemorrhagic Transformation in Acute Large Artery Atherosclerosis Ischemic Stroke Patients with Intravenous Thrombolysis

Background: Hemorrhagic transformation (HT) is a common complication of intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS) and may lead to neurological deterioration. This article discusses whether monocyte count to high-density lipoprotein ratio (MHR) level is associated with HT in AIS patients. Materials and methods: The clinical data of AIS patients who underwent rt-PA IVT treatment were continuously collected. According to whether HT occurred, patients were divided into HT group and non-HT group. Potential association between MHR and HT in different subtypes AIS was explored by using logistic regression. Results: A total of 444 AIS patients were retrospective analyzed. The MHR level was lower in HT group compared with the non-HT group in all AIS patients (0.28 vs 0.36, P = .031) and in large-artery atherosclerosis (LAA) type AIS patients (0.31 vs 0.37, P = .032). Low MHR was independently related to HT (OR:0.035, 95%CI:0.003-0.390, P = .006). Among all TOAST subtypes, low MHR was only independently associated with HT in patients of LAA-type AIS after adjusting for confounding factors (OR:0.01, 95%CI:0.00-0.62, P = .031), with an optimal cut-off value of 0.41, sensitivity of 85.7%, and specificity of 43.1%. MHR was not correlated with SVO, VE, and CE subtype AIS. Conclusion: Low MHR may be an independent predictor of HT in patients with AIS and this conclusion only existed in LAA-type AIS.

A Review of Risk Factors and Predictors for Hemorrhagic Transformation in Patients with Acute Ischemic Stroke

Acute ischemic strokes (AIS) and hemorrhagic strokes lead to disabling neuropsychiatric and cognitive deficits. A serious and fatal complication of AIS is the occurrence of hemorrhagic transformation (HT). HT is cerebral bleeding that occurs after an ischemic event in the infarcted areas. This review summarises how specific risk factors such as demographic factors like age, gender, and race/ethnicity, comorbidities including essential hypertension, atrial fibrillation, diabetes mellitus, congestive heart failure, and ischemic heart disease along with predictors like higher NIHSS score, larger infarction size, cardioembolic strokes, systolic blood pressure/pulse pressure variability, higher plasma glucose levels, and higher body temperature during ischemic event, lower low-density lipoprotein and total cholesterol, early ischemic changes on imaging modalities, and some rare causes make an individual more susceptible to developing HT. We also discuss few other risk factors such as the role of blood-brain barrier, increased arterial stiffness, and globulin levels in patients postreperfusion using thrombolysis and mechanical thrombectomy. In addition, we discuss the implications of dual antiplatelet therapy and the length of treatment in reference to the incidence of developing HT. Current research into inflammatory mediators and biomarkers such as Cyclooxygenase-2, matrix metalloproteinases, and soluble ST2 and their potential role as treatment options for HT is also briefly discussed. Finally, this review calls for more research into use of dual antiplatelet and the timing of antiplatelet and anticoagulant use in reference to hemorrhagic transformation.

AST to ALT ratio and risk of hemorrhagic transformation in patients with acute ischemic stroke

BACKGROUND

Hemorrhagic transformation (HT) is a common complication of ischemic stroke. We performed this study to determine whether aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AAR) was related to HT, as well as compare the predictive values of AAR, ALT and AST for HT in patients with ischemic stroke.

METHODS

We included ischemic stroke patients within 7 days of onset. HT was identified by a follow-up imaging examination. Univariate and multivariate logistic regression models were performed to assess the association between AAR and HT. Net reclassification index (NRI) was calculated to assess the ability of AAR, AST and ALT to reclassify risks of HT.

RESULTS

A total of 2042 (median age: 69 years; 63.2% males) patients were included in this study, of whom 232 (11.4%) were identified as HT. The receiver-operating characteristic curve analysis showed that the optimal cut-off value for AAR to predict HT was 1.22. Higher AAR (≥1.22) was an independent predictor associated with HT (OR 1.44, 95%CI 1.06-1.97, P = 0.02) after adjusting for covariates. A U-shaped dose-effect relationship was found between AAR level and HT in logistic regression model with restricted cubic splines. In addition, adding AAR to a model containing conventional risk factors significantly improved predictive power for HT (NRI: 15.4%, P = 0.027), but not for ALT (NRI: 10.3%, P = 0.141) or AST (NRI: 8.3%, P = 0.237).

CONCLUSIONS

Higher AAR was associated with an increased risk of HT after ischemic stroke. In addition, AAR might be a better biomarker for predicting HT than ALT or AST.

Association between non-high-density lipoprotein cholesterol and haemorrhagic transformation in patients with acute ischaemic stroke

BACKGROUND

It is unclear whether non-high-density lipoprotein cholesterol (Non-HDL-C) is associated with haemorrhagic transformation (HT) after acute ischaemic stroke (AIS). We aimed to explore the association between Non-HDL-C and HT, as well as compare the predictive values of Non-HDL-C and low-density lipoprotein cholesterol (LDL-C) for HT.

METHODS

We consecutively enrolled AIS patients within 7 days of stroke onset. Participants were divided into four categories according to quartiles of Non-HDL-C. HT was assessed by follow-up brain imaging. We assessed the association between Non-HDL-C, LDL-C and HT in multivariate logistic regression analysis.

RESULTS

A total of 2043 patients were included, among whom 232 were identified as HT. Compared with the highest quartiles, the first, second and third quartiles of Non-HDL-C were associated with increased risk of HT (adjusted odds ratios [ORs] 1.74 [95% confidence interval [CI] 1.09-2.78], 2.01[95% CI 1.26-3.20], and 1.76 [95% CI 1.10-2.83], respectively, P for trend = 0.024). Similar results were found for LDL-C. There was significant interaction between Non-HDL-C and age (P for interaction = 0.021). The addition of Non-HDL-C and LDL-C to conventional factors significantly improved predictive values [Non-HDL-C, net reclassification index (NRI) 0.24, 95%CI 0.17-0.31, P < 0.001; LDL-C, NRI 0.15, 95%CI 0.08-0.22, P = 0.03].

CONCLUSIONS

Low Non-HDL-C was associated with increased risks of HT. In addition, Non-HDL-C has similar effects as LDL-C for predicting HT.

The association between monocyte to high-density lipoprotein ratio and hemorrhagic transformation in patients with acute ischemic stroke

Hemorrhagic transformation (HT) is a common complication in patients with acute ischemic stroke. We investigated whether the monocyte to high-density lipoprotein ratio (MHR) is related to HT. Consecutive patients with ischemic stroke within 24 h of symptom onset were included in this study. HT was diagnosed by follow-up brain imaging after admission, and was classified as asymptomatic or symptomatic according to whether patients showed any neurologic worsening. Logistic regression was performed to estimate the association between MHR and HT. Of the 974 enrolled patients, 148 (15.2%) developed HT, and 24 (2.5%) patients experienced symptomatic HT. Compared to the highest MHR tertile (> 0.37), the lowest MHR tertile (< 0.22) was associated with 1.81-fold increase (95% CI 1.08-3.01, P = 0.024) in the odds of HT and 3.82-fold increase (95% CI 1.04-14.00, P = 0.043) in the odds of symptomatic HT after adjustment for possible confounders. Using a multivariate logistic regression model with restricted cubic spline, we found that elevated MHR was associated with a decreased risk of HT and symptomatic HT. In summary, lower MHR was independently associated with increased risk of HT and symptomatic HT in patients with ischemic stroke.