The association of ApoB/ApoA-I ratio with intracranial atherosclerotic stenosis in young patients with ischemic stroke

Q: What are the key findings of this study?

In young patients with ischemic stroke, the highest quartile of the ApoB/ApoA-I ratio was independently associated with an increased risk of intracranial atherosclerotic stenosis (OR 4.743) compared to the lowest quartile.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Ischemic stroke (n=161). Intervention: ApoB/ApoA-I ratio (highest quartile) vs. ApoB/ApoA-I ratio (lowest quartile). Primary outcome: Intracranial atherosclerotic stenosis (ICAS) (OR 4.743, 95% CI 2.109-10.667, p=<0.001).

Q: What does this research mean for the field?

A higher ApoB/ApoA-I ratio is independently associated with a dose-dependent increased risk of intracranial atherosclerotic stenosis in young patients with ischemic stroke. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the association between the serum apolipoprotein B (ApoB)/apolipoprotein A-I (ApoA-I) ratio and intracranial atherosclerotic stenosis (ICAS) in young patients presenting with ischemic stroke.

Meijuan Yan; Lihui Shao

doi:10.3389/fneur.2026.1820967

May 21, 2026Frontiers in NeurologyOpen Access

The association of ApoB/ApoA-I ratio with intracranial atherosclerotic stenosis in young patients with ischemic stroke

View Full Paper

Ask AI

Bookmark

Share

Key result

Highest ApoB/ApoA-I quartile linked to ~374% higher ICAS risk in young ischemic stroke patients.

OR 4.743
95% CI 2.109-10.667
P<0.001
n=161

Figures

Why the study?

Ischemic stroke incidence among young adults has increased significantly, making the identification of risk factors in this demographic crucial for effective prevention.

Is a higher serum ApoB/ApoA-I ratio associated with intracranial atherosclerotic stenosis in young patients with ischemic stroke?

Key Points

To evaluate the association between the serum apolipoprotein B (ApoB)/apolipoprotein A-I (ApoA-I) ratio and intracranial atherosclerotic stenosis (ICAS) in young patients presenting with ischemic stroke.
Analyzed 161 young ischemic stroke patients aged 18 to 45 years (mean age 39.0 ± 5.7 years; 119 males and 42 females) out of 230 initially recruited.
Assessed ICAS using computed tomography angiography (CTA) to divide subjects into an ICAS group (n = 89) and a non-ICAS group (n = 72).
Measured lipid parameters and conducted multivariable logistic regression adjusted for age, sex, smoking, hypertension, diabetes mellitus, and HDL-C.
Patients with ICAS presented with significantly higher mean ApoB/ApoA-I ratios (1.14 ± 0.26 vs 0.88 ± 0.21, p < 0.001) and ApoB levels (1.02 ± 0.25 vs 0.89 ± 0.22 g/L, p = 0.001), alongside lower ApoA-I levels (0.89 ± 0.21 vs 1.01 ± 0.26 g/L, p = 0.001).
Multivariable logistic regression demonstrated a dose–response relationship across ApoB/ApoA-I quartiles: Q2 adjusted OR = 3.051 (95% CI, 1.185–7.855, p = 0.021), Q3 adjusted OR = 3.516 (95% CI, 1.504–8.219, p = 0.004), and Q4 adjusted OR = 4.743 (95% CI, 2.109–10.667, p < 0.001) compared with Q1.
Standard lipid concentrations did not significantly differ between the ICAS and non-ICAS cohorts for LDL-C (3.15 ± 0.85 vs 2.98 ± 0.74 mmol/L, p = 0.183) or total cholesterol (median 4.91 vs 4.63 mmol/L, p = 0.106).

Study Design

Type

Observational (n=161)

Multicenter

No

Structured PICO

Is a higher serum ApoB/ApoA-I ratio associated with intracranial atherosclerotic stenosis in young patients with ischemic stroke?

P

Population

161 young patients (aged 18 to 45 years, mean age 39.0 ± 5.7, 119 males) with acute ischemic stroke admitted within 48 hours of symptom onset. Excluded non-atherosclerotic arteriopathies, cardiogenic embolism, and hemorrhagic stroke.

I

Intervention

Higher serum ApoB/ApoA-I ratio (analyzed in quartiles)

C

Comparator

Lowest quartile (Q1) of serum ApoB/ApoA-I ratio

O

Outcome

Presence of intracranial atherosclerotic stenosis (ICAS) defined as >50% stenosis or occlusion on computed tomography angiography (CTA)surrogate

Main Result

Effect estimate: OR 4.743 (95% CI 2.109-10.667)

p-value: p=<0.001

In young adults with ischemic stroke, a higher ApoB/ApoA-I ratio is strongly and independently associated with the presence of intracranial atherosclerotic stenosis.

Limitations

Lack of routine vessel wall magnetic resonance imaging or high-resolution conventional angiography to definitively exclude non-atherosclerotic arteriopathies.
No prespecified systematic adjudication protocol for coexisting lesions, which may introduce misclassification bias.
CTA performed within 1 week of symptom onset may not reliably distinguish fixed atherosclerotic stenosis from transient acute thrombotic changes.
Single-center, observational, and cross-sectional nature precludes definitive causal inference and may introduce unmeasured confounding.
ApoB and apoAI were measured in the acute period (within 48 h).
Retrospective design
Only CTA available for vascular imaging (lack of vessel wall MRI to definitively exclude non-atherosclerotic causes)
Cross-sectional data cannot determine causality or treatment efficacy

Implication

Should not yet change lipid assessment in young stroke; hypothesis-generating for ICAS risk stratification pending prospective validation.

Abstract

In recent years, the incidence of ischemic stroke among young adults has increased significantly. Identifying risk factors associated with ischemic stroke in this demographic is crucial for effective prevention. This study aimed to investigate the relationship of the serum apolipoprotein B (ApoB)/apolipoprotein A-I (ApoA-I) ratio with intracranial atherosclerotic stenosis (ICAS) in young patients with ischemic stroke. We collected data from patients with ischemic stroke aged 18 to 45 years. ICAS was assessed using computed tomography angiography (CTA), and serum levels of total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, ApoA-I, and ApoB were measured. The ApoB/ApoA-I ratio was subsequently calculated. Demographic and clinical characteristics were compared between the ICAS group and the non-ICASs group. Multivariate logistic regression analysis was employed to identify independent risk factors for ICAS in young ischemic stroke patients. A total of 161 young ischemic stroke patients were included, with 89 in the ICAS group and 72 in the non-ICAS group. In a univariate analysis, patients with ICAS had a higher prevalence of diabetes mellitus, smoking, and hyperlipidemia, as well as higher levels of ApoB and a higher ApoB/ApoA-I ratio, but lower levels of HDL-C and ApoA-I compared to those without ICAS. After adjustment for age, sex, smoking, hypertension, diabetes mellitus, and HDL-C, multivariable analyses indicated that ICAS had a dose–response relationship with apoB/apoAI ratio quartiles: the second quartile, OR, 3.051 (95% CI, 1.185 to 7.855); the third quartile, 3.516 (1.504 to 8.219); and the fourth quartile, 4.743 (2.109 to 10.667), when referenced to the first quartile. Our study showed that a higher apoB/apoAI ratio is independently associated with ICAS in young stroke patients, after careful exclusion of alternative arteriopathies and adjustment for confounders. However, findings should be confirmed with vessel wall imaging in future studies.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Yan et al. (2026) conducted an observational in Ischemic stroke (n=161). ApoB/ApoA-I ratio (highest quartile) vs. ApoB/ApoA-I ratio (lowest quartile) was evaluated on Intracranial atherosclerotic stenosis (ICAS) (OR 4.743, 95% CI 2.109-10.667, p=<0.001). In young patients with ischemic stroke, the highest quartile of the ApoB/ApoA-I ratio was independently associated with an increased risk of intracranial atherosclerotic stenosis (OR 4.743) compared to the lowest quartile.

synapsesocial.com/papers/6a13e60e0e02ee3982d313b5 https://doi.org/10.3389/fneur.2026.1820967

View Full Paper

Ask AI

Bookmark

Share

The association of ApoB/ApoA-I ratio with intracranial atherosclerotic stenosis in young patients with ischemic stroke

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

The association of ApoB/ApoA-I ratio with intracranial atherosclerotic stenosis in young patients with ischemic stroke

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading