Higher High‐Density Lipoprotein Cholesterol Levels Are Associated With an Unfavorable Outcome After Thrombolysis for Stroke: The Lipid Paradox

Background Effects of serum cholesterol levels on stroke outcomes remain controversial, especially in intravenous thrombolysis (IVT)–treated patients. This study explored the association between lipid levels and outcomes in patients with acute ischemic stroke (AIS) who received IVT with recombinant tissue plasminogen activator (rt‐PA). Methods AIS patients who received rt‐PA thrombolysis from April 2015 to December 2018 were retrospectively enrolled. Fasting lipid profiles, including total cholesterol, triglycerides, low‐density lipoprotein cholesterol, and high‐density lipoprotein cholesterol (HDL‐C), were collected. Stroke outcomes included hemorrhagic transformation, 3‐month unfavorable outcome (modified Rankin scale > 2), and 3‐month mortality. Results We enrolled 698 IVT‐treated patients with AIS. Binary logistic regression analysis showed that a higher HDL‐C level was independently associated with a higher risk of a 3‐month unfavorable outcome (odds ratio 1.999, 95% confidence interval 1.204–3.320, p = 0.007). Patients were then divided into high and low HDL‐C groups according to a cutoff HDL‐C of 1.415 mmol/L. After propensity score matching to adjust for baseline factors, patients in the high HDL‐C group were more likely to experience a 3‐month unfavorable outcome than those in the low HDL‐C group ( p = 0.041). Conclusions A higher HDL‐C level was independently associated with a 3‐month unfavorable outcome in IVT‐treated patients with AIS. The current study received approval from the Ethics Committee of the First Hospital of Jilin University (No. NCT05028868).