Relationship between carotid atherosclerotic plaques and 90-day prognosis after acute ischemic stroke mediated by multiple inflammatory factors: A cohort and Mendelian randomization study

Abstract

Background

We explored the relationship between maximum carotid plaque thickness (cPTmax), carotid intima-media thickness (cIMT), and the 90-day prognosis of patients with acute ischemic stroke (AIS), as well as the mediating roles of inflammatory factors.

Methods

We enrolled 951 patients with AIS who underwent carotid artery ultrasonography between June 2019 and November 2023. cPTmax, monocytes (Mono) and the calculated lymphocyte-monocyte ratio (LMR) and monocyte-to-high-density lipoprotein ratio (MHR) values were obtained. Receiver operating characteristic (ROC) curve analysis was used to determine the sensitivity and specificity of Mono, LMR, and MHR as mediating variables, and their predictive value for poor prognosis was evaluated. We then performed two-sample Mendelian randomization to estimate the independent effect of cIMT on IS and explored the mediation effect of oncostatin M (OSM).

Results

cPTmax was positively correlated with the poor outcomes (p < 0.001). Mediation analysis revealed that multiple inflammatory factors, including Mono, LMR, and MHR, acted as positive mediators. In the two-sample Mendelian randomization, we found that cIMT was positively associated with ischemic stroke (β = 3.115, 95 % CI: 1.519–4.710), whereas OSM played a negative mediating role, with a mediating effect value of 7.5 %.

Conclusions

Our cohort study showed a positive correlation between cPTmax and poor prognosis 90 days after acute stroke, with Mono, LMR, and MHR mediating this process. A Mendelian randomization (MR) study showed a causal relationship between an increase in cIMT and an increased risk of IS. The mediating role of OSM in this process can reduce the risk of IS.