Investigating the association between low-density lipoprotein cholesterol/high-density lipoprotein cholesterol and the risk of carotid artery plaque in patients with first-ever ischemic stroke based on different glucose metabolic conditions

Objective This study investigated the association between the low-density lipoprotein cholesterol (LDL-C)/high-density lipoprotein cholesterol (HDL-C) ratio and carotid plaque risk in patients with first-ever ischemic stroke (IS). We focused on analyzing the differences in this association across different Glucose Metabolic Conditions, preliminarily explored the roles of glycated hemoglobin (HbA1c) and fasting plasma glucose (FPG) in this association, and thereby provided a basis for future prospective studies and risk assessment of IS events. Methods This retrospective study included 12,166 patients hospitalized for first-time IS at the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from January 1, 2013, to May 1, 2023. The LDL-C/HDL-C–carotid plaque risk association across glucose metabolism statuses was assessed employing logistic regression, stratified analysis, and exploratory mediation analyses. Results Of 12,166 participants, 9,469 (77.8%) had carotid plaque. Univariate logistic regression showed that LDL-C/HDL-C had a stronger association with the risk of carotid plaque formation than other lipid parameters (LDL-C, total cholesterol, and triglycerides). Multivariate analysis confirmed a significant positive association. Stratified analyses revealed that the association between LDL-C/HDL-C and plaque risk was relatively stronger in the Pre-DM cohort (odds ratio [OR]: 1.233, 95% confidence interval [CI]: 1.093–1.391), followed by patients with diabetes mellitus (OR: 1.178, 95% CI: 1.074–1.293); no significant association appeared in individuals with normal glucose regulation. Exploratory mediation analysis showed HbA1c and FPG accounted for 11.5% and 10.5% of the LDL-C/HDL-C–carotid plaque risk association, respectively. Conclusion The findings of this study present that elevated LDL-C/HDL-C was significantly associated with carotid atherosclerosis in patients with IS, and this association was particularly stronger in the Pre-DM cohort. HbA1c and FPG had a certain moderating effect on this association, suggesting that the Pre-DM stage is a potential intervention window for focusing on LDL-C/HDL-C. LDL-C/HDL-C may serve as a reference indicator for clinically assessing the synergistic risk of “lipid-glucose co-morbidity,” which holds significant value for the secondary prevention of IS events.