The Association between Fasting Remnant Cholesterol and White Matter Hyperintensities in Acute Ischemic Stroke Patients.

Introduction: This study aims to examine the correlation between fasting remnant cholesterol (RC) levels and white matter hyperintensities (WMHs) in patients diagnosed with acute ischemic stroke (AIS).

Methods: Patients diagnosed with AIS were enrolled from the Department of Neurology at the affiliated Suzhou Hospital of Nanjing Medical University. The burden of WMHs was evaluated using the Fazekas scale on magnetic resonance imaging. RC was calculated as total cholesterol (TC) - high-density lipoprotein cholesterol (HDL-C) - low-density lipoprotein cholesterol (LDL-C). WMHs severity was categorized using Fazekas scores: low WMHs (0-3 points) and high WMHs (≥4 points). The relationship between RC levels and the burden of WMHs was examined through multivariate logistic regression and restricted cubic spline (RCS) logistic regression analyses. Finally, subgroup analyses were performed.

Results: A total of 650 patients with AIS were included in this study. The RC levels in the low-WMHs group were significantly higher than those in the high-WMHs group (t = 3.45, p < 0.05). When RC was treated as a continuous variable for logistic regression analysis, in fully adjusted models, there was a negative correlation between RC and WMHs scores (OR: 0.314, 95% CI: 0.143-0.685, p < 0.05). When RC was categorized, in fully adjusted models, there was a significant inverse association was observed in the highest RC quartile compared with the lowest (OR: 0.598, 95% CI: 0.372-0.961, p < 0.05). Using RCS analysis, when RC was ≥0.57 mmol/L, there was a negative correlation between RC and WMHs scores (OR: 0.179, 95% CI: 0.04-0.554, p < 0.05), and as RC values increased, the WMHs scores decreased. In subgroup analysis, there was a negative correlation between RC and WMHs, especially in males.

Conclusion: This study suggests that maintaining RC levels of ≥0.57 mmol/L during the acute phase of AIS may be associated with a reduction in WMHs burden, particularly among males. However, further prospective trials are required to validate its safety and efficacy.