ABSTRACT NUMBER: ESOC2026A1534 ADVANCED LIPOPROTEIN PROFILING AND ITS ASSOCIATION WITH CEREBROVASCULAR DISEASE

Abstract Background and aims Traditional lipid testing may not capture the full risk associated with the lipoprotein molecule, whose metabolism plays a central, yet modifiable role in cerebrovascular disease pathogenesis. Nuclear magnetic resonance spectroscopy enables detailed lipid compositional analysis and quantifies particle concentration and size, offering insight into lipid profiles relevant to cerebrovascular disease. Methods This retrospective cohort study included 355 adults at a tertiary hospital who underwent advanced lipid profiling, and brain and vascular imaging. Participants were categorized by clinical and radiological evidence of cerebrovascular and white matter disease, and lipoprotein parameters were compared across categories to identify associations with cerebrovascular disease subtypes. Results Embolic stroke unknown etiology, (20.3%) and carotid disease (13.1%) were the most frequent diagnoses. White matter lesions were present in 75.9%. Periventricular Fazekas scores of 1–3 were evident in 69.6%, and deep Fazekas scores 1–3 in 66.5% patients. For periventricular WML, higher burden was significantly associated with lower HDL-C, HDL-P and large HDL-P (p < 0.001), alongside larger HDL and LDL particle size reductions. Conversely, higher periventricular scores correlated positively with LDL-C, VLDL-P, small and medium VLDL-P, LDL-P, ApoB, and non-HDL cholesterol, indicating higher atherogenicity. When comparing NMR- derived lipoprotein subfractions with white matter disease, ischemic stroke and TIA, we found IDL-C, LDL-TG, Medium LDL-P and chylomicrons differed significantly across the groups (p = 0.032). Conclusions NMR-derived lipoprotein subfractions were associated with cerebrovascular phenotypes, particularly periventricular white-matter lesion burden, which correlated with a more atherogenic profile. These findings suggest particle-based lipid metrics may provide added risk stratification beyond standard LDL-C. Conflict of interest Muna S. Alnamlah: nothing to disclose, Mohammed Alqurishi: nothing to disclose, Adi A. Aldubaiyan: nothing to disclose, Mohammed Alkhudair: nothing to disclose, Haifa Alsuwaine: nothing to disclose, Ouf Aloofy: nothing to disclose, Ashfaq Shuaib: nothing to disclose, Ashfaq Shuaib: nothing to disclose, Fahad Alajlan: nothing to disclose, Naser Alotaibi: nothing to disclose