Dyslipidemia versus Obesity as Predictors of Ischemic Stroke Prognosis: A Multi-Center Study in China

Abstract

Abstract Background This multicenter observational study aimed to determine whether dyslipidemia or obesity contributes more significantly to unfavorable clinical outcomes in patients experiencing a first-ever ischemic stroke (IS). Methods We employed a machine learning predictive model to investigate associations among body mass index (BMI), body fat percentage (BFP), high-density lipoprotein (HDL), triglycerides (TG), and total cholesterol (TC) with adverse outcomes in IS patients. Extensive real-world clinical data was utilized, and risk factors significantly linked to adverse outcomes were identified through multivariate analysis, propensity score matching (PSM), and regression discontinuity design (RDD) techniques. Furthermore, these findings were validated via a nationwide multicenter prospective cohort study. Results In the derived cohort, we assessed a total of 45,162 patients diagnosed with IS, where 522 experienced adverse outcomes. Our multifactorial analysis incorporating PSM and RDD methods identified TG (adjusted OR 95%CI, 1.110 (1.041–1.183), P < 0.01) and TC (adjusted OR 95%CI, 1.139 (1.039–1.248), P < 0.01) as risk factors. However, BMI, BFP, and HDL showed no significant effect. In the validation cohort, 1410 controls and 941 patients were enrolled—confirming that lipid levels are more strongly correlated with the prognosis of IS patients compared to obesity (TC, OR 95%CI, 1.369 (1.069–1.754), P < 0.05; TG, OR 95%CI, 1.332 (1.097–1.618), P < 0.01). Conclusion This study suggests that dyslipidemia has a more substantial impact on the prognosis of IS patients compared to obesity. This highlights the importance of prioritizing dyslipidemia management in the treatment and prevention of adverse outcomes in IS patients.