Impaired lipoprotein cholesterol ratio is associated with cognitive impairment in patients with stroke

1. Non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) was independently associated with early cognitive impairment in patients with mild acute ischemic stroke.

Evidence Rating Level: 3 (Average)

Patients with acute ischemic stroke (AIS) commonly exhibit early cognitive impairment, which adversely impacts their quality of life and functional recovery. Dyslipidemia is an independent risk factor for AIS and plays an important role in cognitive impairment. Although evidence suggests that non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is more effective than traditional lipid parameters in predicting the risk of various cardiometabolic conditions, limited research exists on its relationship with early cognitive function in patients with AIS. This study thus examined the association between NHHR and early cognitive impairment in patients with AIS. This cross-sectional study included patients with AIS admitted to a hospital in China between January 2023 and January 2025. Cognitive function was evaluated within two weeks of acute cerebral infarction using the Mini-Mental State Examination (MMSE), with cognitive impairment determined by education-stratified thresholds. NHHR was calculated as total cholesterol—HDL-C)/HDL-C. Patients were stratified by NHHR into quartiles: Q1 (0.544–2.072), Q2 (2.072–2.904), Q3 (2.904–3.918), Q4 (3.918–15.591). Out of the 817 patients included in the study, 473 had cognitive impairment (mean age [SD] = 66.12 [9.62] years, male [%] = 312 [65%]) and 344 had normal cognition (mean age [SD] = 59.54 [9.77] years, male [%] = 234 [68%]). There was a dose-response relationship between NHHR quartiles and the incidence of cognitive impairment, with rates increasing from 51.7% in Q1 to 63.7% in Q4 (trend test P = 0.021). Multivariate regression analysis revealed each unit increase in NHHR was associated with a 13.2% increased risk of cognitive impairment (OR = 1.13, 95% confidence interval (CI) 1.02–1.25, P = 0.018). Overall, this study found NHHR to be a risk factor for early cognitive impairment in patients with AIS, highlighting its importance as a potential biomarker for cognitive decline in this population. Future longitudinal studies are needed to confirm these findings.

Click to read the study in EJMR

Image: PD

©2025 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.