Association of Triglyceride/High-density Lipoprotein Cholesterol Ratio with the Clinical Prognosis of Ischemic Stroke Patients: A Systematic Review with Meta-analysis
Claudia Cruzalegui Bazán1, Mario Chavez Hermosilla1, Patricio Castro Suarez1, Arturo Duran-Pecho1, Miguel Cabanillas Lazo1, Carlos Alva-Diaz2
1Sociedad Científica de San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Peru, 2Red de Eficacia Clínica y Sanitaria (REDECS), Lima, Peru
Objective:
To conduct a systematic review with meta-analysis to synthesize the evidence on the prognostic value of Triglyceride/High-density lipoprotein cholesterol ratio (TG/HDLc) on Ischemic stroke (IS).
Background:
The ethyology of Ischemic stroke is related to lipid metabolism alterations that result in atherosclerosis build-up. Currently, the TG/HDLc is a non-traditional lipid parameter being studied as a promising predictor of cardiovascular events, including IS, and their clinical outcomes.
Design/Methods:
A systematic search was conducted in PubMed, Embase, Scopus, Web of Science, and Google Scholar until June 2023. The risk of bias was assessed with the NewCastle-Ottawa tool. A meta-analysis with randomized effects model was applied using the DerSimonian-Laird estimator to calculate the pooled effect of the outcome and a narrative synthesis when this was not possible. GRADE criteria were used to assess the certainty of the evidence.
Results:
Seven out of 555 articles were selected. Decreased TG/HDLc value was associated with lower mortality rate at 3 months (OR: 0.36; 95%CI: 0.24-0.54; I2=0%) with moderate certainty and lower occurrence of hemorrhagic transformation at one week (OR: 0.59; 95%CI: 0.42-0.81; I2=0%), with low certainty level. With high certainty, increased TG/HDLc was related to a motor sequelae (≥3 modified Rankin scale score) and post-IS cognitive impairment, while the association of this index with severity of IS (National Institutes of Health Stroke Scale score) was assessed with moderate certainty level.
Conclusions:
With an analysis of a limited amount of studies, we found with a low level of certainty that TG/HDLc ratio is a useful tool for predicting acute outcomes (hemorraghic transformation and severity); while, with a moderate certainty we reported its utility for late outcomes (motor and cognitive sequelae). However, further prospective studies with community-representative samples of diverse populations are needed.