Triglyceride-HDL index as a predictor of post-stroke outcomes: A retrospective analysis of 6,235 ischemic stroke patients from the Qatar Stroke Database

Abstract

Objectives: In this study, we explored the Qatar stroke database to study the independent effect of sex- specific TG-HDL index on neurologic and cardiovascular outcomes following stroke in a predominantly Arab and Southeast Asian population.

Methods: All patients admitted with acute ischemic stroke between 2014-2022 were included. TG-HDL index on admission was calculated and patients were stratified into sex-specific quartiles. We studied the 90-day modified Rankin Score (mRS), and 1-year major cardiac adverse events (MACE). Multivariate linear and binary logistic regression analyses were performed to identify the independent effect of TG-HDL index on short- and long-term outcomes.

Results: A total of 6,235 stroke patients were identified. Overall, mean age was 55±13 years; 5,122 patients (82%) male; 1,989(32%) Arab; 1,628(26%) BMI ≥30; 3,526 (57%) diabetes mellitus; 4,598 (74%) hypertension, 3,158 (51%) dyslipidemia, and 1,876 (30%) smokers. The median TG levels were 1.5 (1.0-2.3), HDL levels 1.0 (0.8-1.2), and TG-HDL index was 1.5 (1.0-2.3). On long term follow-up, 120 (2%) had a recurrent stroke, 314 (5.1%) had MACE, 38 (0.6%) had post-stroke MI, and 37 (0.6%) had post-stroke cardiac revascularization procedures. On multivariate analyses, higher sex-specific TG-HDL index was independently associated with lower adjusted odds of severe stroke and lower inpatient mortality, and higher 1-year adjusted odds of post-stroke MI (p<0.05).

Conclusion: TG-HDL was strongly associated with in-patient mortality and long-term post-stroke cardiovascular outcomes but not long-term stroke recurrence. Our finding of an independently increased 1-year risk of post-stroke MI with higher TG-HDL index may warrant consideration of this index as a cardiac risk stratification tool for stroke patients.