Assessing the Pathological Correlation Between High-Density Lipoprotein Fractions and Acute Intracerebral Hemorrhage: A Clinical Match-Control Study

Background: Although high HDL-C traditionally protects against arterial blockages, emerging evidence suggests it may paradoxically increase the risk of severe spontaneous brain bleeds. Objective: This hospital-based study evaluated the association between serum HDL-C status and acute hemorrhagic stroke within the Bangladeshi population. Methodology: This age- and gender-matched observational case-control study was conducted at Dhaka Medical College Hospital over an 18-month period (July 2018 to January 2020). It evaluated 296 adult participants, comprising 148 acute cases with radiologically confirmed, non-traumatic parenchymal hemorrhage presenting within 14 days and 148 matched healthy controls; patients on lipid-lowering or antithrombotic therapies and those with secondary bleeding etiologies were excluded. Following baseline blood pressure and admission GCS logging, fasting venous blood samples were analyzed for lipid profiles via automated enzymatic systems. Statistical evaluation was performed using unpaired Student's t-tests, Chi-square tests, and multivariate binary logistic regression to isolate independent odds ratios (p < 0.05). Results: Mean fasting HDL-C tiers were significantly elevated in stroke patients compared to healthy individuals (50.01 ± 9.95 mg/dL vs. 45.69 ± 9.71 mg/dL, p<0.001). Conversely, mean total cholesterol was depressed among cases (171.01 ± 32.15 mg/dL vs. 183.34 ± 32.82 mg/dL, p=0.001). Adjusted multivariate frameworks identified four independent indicators for acute cerebral bleeding: preexisting hypertension (OR: 3.788, p<0.001), fasting HDL-C ≥ 50 mg/dL (OR: 2.870, p<0.001), current smoking habits (OR: 2.417, p=0.005), and severe hypocholesterolemia <160 mg/dL (OR: 2.359, p=0.003). Localized hematoma diameter did not significantly correlate with absolute HDL-C values (r = -0.094, p=0.256). Conclusion: Elevated circulating fractions of HDL-C combined with low total cholesterol independent of advanced age show an independent association with spontaneous brain hemorrhage in Bangladeshi adults. Journal of National Institute of Neurosciences Bangladesh, January 2026;12(1):9-14