@article{Ruan2026, 
author = {Hang Ruan and Qin Zhang and Ping Zhang and Yingxin Tang and Xiao Ran},
title = {Prognostic value of TC/HDL-C ratios in ischemic stroke: a multicenter observational study},
year = {2026},
journal = {Brain Hemorrhages},
volume = {7},
number = {2},
pages = {82-90},
keywords = {Cerebrovascular disorders, Ischemic stroke, High-density lipoproteins, Cholesterol, Regression discontinuity design (RDD)},
url = {https://www.sciopen.com/article/10.1016/j.hest.2026.01.003},
doi = {10.1016/j.hest.2026.01.003},
abstract = {ObjectiveThis study aimed to determine the relationship between the total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio and adverse outcomes in patients with first-ever ischemic stroke (IS), and to validate its potential as a prognostic indicator.MethodsA dual-cohort study integrating retrospective and prospective designs was conducted. The retrospective cohort included 45,162 patients with first-ever IS, and the prospective cohort comprised an independent sample of 2151 patients with first-ever IS. The primary outcome was a composite of stroke recurrence or all-cause death within five years. In the retrospective cohort, logistic regression and regression discontinuity design (RDD) were used to assess the relationship between TC/HDL-C ratio and adverse outcomes, adjusting for confounding factors (e.g., age, sex, comorbidities, and medication use). In the prospective cohort, logistic regression was employed to validate the association, with Kaplan-Meier survival analysis used to characterize prognosis across TC/HDL-C subgroups. Odds ratio (OR) and 95% confidence interval (CI) were calculated.ResultsIn the retrospective cohort, a higher TC/HDL-C ratio was identified as an independent risk factor for Five-year adverse outcomes (univariate analysis: OR 1.35 (95% CI, 1.28–1.42), P < 0.001; multivariate analysis: OR 1.30 (95% CI, 1.22–1.39), P < 0.001), and this association was confirmed by RDD. In the prospective cohort, logistic regression replicated these findings, with each unit increase in TC/HDL-C associated with a 12% higher risk of adverse outcomes [OR 1.12 (95% CI, 1.02–1.23), P < 0.05]. Kaplan-Meier analysis further showed that patients with lower TC/HDL-C ratios had significantly longer event-free survival over the 5-year follow-up (log-rank P < 0.001).ConclusionElevated TC/HDL-C ratio is independently associated with an increased risk of stroke recurrence or death within 5 years in patients with first-ever IS. These findings support the utility of the TC/HDL-C ratio as a clinically relevant prognostic marker for long-term outcomes in IS patients.}
}