The association of non-traditional lipid profiles with ischemic stroke subtypes and recurrent stroke

Introduction: Lipid abnormalities are significant risk factors in patients with stroke. Recent studies have demonstrated that non-traditional lipid parameters play a critical role in the development of atherosclerosis. In this study, we aimed to investigate the relationship between non-traditional lipid parameters, ischemic stroke subtypes, and recurrent ischemic stroke in patients with ischemic stroke Materials and Methods: Between January 1, 2023, and January 1, 2024, data from 484 patients diagnosed with ischemic stroke at Afyon Health Sciences University were retrospectively analyzed. Patients with hemorrhagic stroke, transient ischemic attack, or cerebral venous sinus thrombosis were excluded. Non-traditional lipid parameters, including TG/HDL-C, Non-HDL-C/HDL-C, CRI-I, CRI-II, and AIP, were evaluated. Factors associated with stroke subtypes and recurrence were analyzed using logistic regression, while the predictive ability of lipid parameters for recurrence was assessed by ROC analysis (p<0.05 considered statistically significant). Results: A total of 484 patients diagnosed with ischemic stroke and admitted to the Neurology Department and Outpatient Clinic of Afyon Health Sciences University Faculty of Medicine were included in the study. Regarding atherogenic indices, the CE group had the lowest values for Non-HDL-C/HDL-C (p=0.031), CRI-I (p=0.036), and AIP (p=0.037). The presence of dyslipidemia was significantly associated with recurrence (p<0.001). According to ROC analysis, LDL (AUC=0.628, p<0.001), total cholesterol (AUC=0.611, p=0.001), non-HDL (AUC=0.594, p=0.006), and CRI-II (AUC=0.582, p=0.018) were significant in distinguishing recurrence. Triglyceride levels showed a significant positive association with small vessel (SV) stroke (p=0.033, OR=1.003, 95% CI: 1.000–1.005). Conclusion: In this study, lower lipid levels and atherogenic indices in cardioembolic strokes supported an embolic origin, whereas higher lipid levels in large and small vessel strokes indicated atherosclerotic mechanisms. Elevated triglyceride levels were associated with microvascular pathology in small vessel disease. CRI-II emerged as a significant predictor of recurrence. These findings suggest that non-traditional lipid parameters may provide valuable insights beyond conventional lipid measurements in risk assessment and therapeutic strategies.