Association between non-high-density lipoprotein cholesterol and haemorrhagic transformation in patients with acute ischaemic stroke

Background : It is unclear whether non-high-density lipoprotein cholesterol (Non-HDL-C) is associated with haemorrhagic transformation (HT) after acute ischaemic stroke (AIS). We aimed to explore the association between Non-HDL-C and HT, as well as compare the predictive values of Non-HDL-C and low-density lipoprotein cholesterol (LDL-C) for HT. Methods: We consecutively enrolled AIS patients within 7 days of stroke onset. Participants were divided into four categories according to quartiles of Non-HDL-C. HT was assessed by follow-up brain imaging. We assessed the association between Non-HDL-C, LDL-C and HT in multivariate logistic regression analysis. Results: A total of 2043 patients were included, among whom 232 were identified as HT. Compared with the highest quartiles, the first, second and third quartiles of Non-HDL-C were associated with increased risk of HT (adjusted Odds ratios [ORs] 1.74 [95% Confidence Interval [CI] 1.09-2.78], 2.01[95% CI 1.26-3.20], and 1.76 [95% CI 1.10-2.83], respectively, P for trend=0.024). Similar results were found for LDL-C. There was significant interaction between Non-HDL-C and age ( P for interaction=0.021). The addition of Non-HDL-C and LDL-C to conventional factors significantly improved predictive values (Non-HDL-C, net reclassification index [NRI] 0.24, 95%CI 0.17-0.31, P<0.001; LDL-C, NRI 0.15, 95%CI 0.08-0.22, P=0.03). Conclusions: Low Non-HDL-C was associated with increased risks of HT. In addition, Non-HDL-C has similar effects as LDL-C for predicting HT.