Key result
PHR shows no linear link to overall stroke but exhibits a U-shaped relationship.
Why the study?
The platelet to high-density lipoprotein cholesterol ratio is an emerging indicator reflecting thrombogenesis and lipid metabolism inflammation, but its relationship with stroke and its subtypes required investigation.
Does the platelet to high-density lipoprotein cholesterol ratio (PHR) predict the risk of incident stroke and its subtypes in adults without prior stroke?
Cohort (n=400,318)
Yes
Does the platelet to high-density lipoprotein cholesterol ratio (PHR) predict the risk of incident stroke and its subtypes in adults without prior stroke?
Hazard Ratio: 1.02 (95% CI 0.97–1.07)
PHR exhibits a non-linear, subtype-dependent association with stroke risk, where elevated levels correlate with increased ischemic stroke risk and low levels with increased intracerebral hemorrhage risk.
PHR may stratify primary stroke risk; leaves open incremental value beyond established markers and needs prospective validation.
The platelet to highdensity lipoprotein cholesterol ratio (PHR) is an emerging indicator reflecting the balance between thrombogenesis and lipid metabolism inflammation. This study aimed to investigate the relationship between PHR and stroke and its subtypes (ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage). This study included 400,318 participants without prior stroke history in the UK Biobank. Participants were grouped according to PHR tertiles. Cox proportional hazards regression models were employed to assess the association between PHR and stroke occurrence and subtypes, progressively adjusting for demographic, lifestyle, and metabolic covariates. Restricted cubic spline (RCS) analysis examined nonlinear relationships, while the Fine and Gray competing risks model evaluated cumulative incidence of stroke across PHR groups. The receiver operating characteristic (ROC) curves were performed to explored the additional predictive value of PHR. A total of 16,169 stroke events occurred during follow-up. After multivariable adjustment, PHR showed no significant association with stroke [1.02 (0.97, 1.07)]. However, subtype analysis indicated a positive association of PHR with ischemic stroke [1.10 (1.03, 1.18)] and inversely with intracerebral hemorrhage [0.77 (0.66, 0.90)]. RCS analysis revealed significant nonlinear associations between PHR and stroke risk: U-shaped for overall stroke, J-shaped for ischemic stroke, and L-shaped for intracerebral hemorrhage. The ROC curves indicated that the inclusion of PHR significantly improved the model’s predictive performance. A non-linear association exists between PHR and stroke risk, with opposing directions for ischemic stroke and intracerebral hemorrhage. PHR may serve as a potential marker reflecting the balance between platelet activation and lipid metabolism inflammation, offering novel insights for stroke risk assessment and prevention strategies.
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Fengxiao et al. (2026) conducted a cohort in Stroke (n=400,318). Platelet to high-density lipoprotein cholesterol ratio (PHR) vs. Lower PHR tertiles was evaluated on Incident stroke (HR 1.02, 95% CI 0.97, 1.07). The platelet to high-density lipoprotein cholesterol ratio (PHR) showed no significant linear association with overall stroke risk (HR 1.02), but exhibited a U-shaped non-linear relationship with stroke and divergent associations with its subtypes.
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