Association of Nontraditional Lipid Parameters With Long‐Term Prognosis of Acute Ischemic Stroke: A Principal Components Analysis

Background Lipids can adversely affect the prognosis of acute ischemic stroke (AIS). Unlike traditional lipids, nontraditional parameters can offer more extensive insights, but their significance in AIS remains unexplored. This study aimed to evaluate the association between 11 lipid parameters and AIS comprehensively. Methods We leveraged data from 1858 participants with AIS without intravenous thrombolysis to examine the relationship between nontraditional lipid parameters and 1‐year prognostic outcomes. The principal component analysis was used to comprehensively assess the prognostic value of nontraditional lipid parameters. Results Four nontraditional lipid parameters, plasma atherosclerotic index, atherosclerosis coefficient, Castelli’s index‐II, and lipoprotein combine index were selected by random forest. Among them, Castelli’s index‐II was the strongest and most comprehensive predictor of the prognosis of patients with AIS and was associated with 1‐year all‐cause mortality (hazard ratio [HR],0.571 [95% CI, 0.342–0.954], P =0.032), all‐cause hospital readmission (HR, 1.364 [95% CI, 1.004–1.852], P =0.047), and prolonged length of hospital stay (odds ratio [OR], 1.204 [95% CI, 1.097–1.321], P <0.001). Higher principal component analysis scores of nontraditional lipid parameters were associated with lower 1‐year all‐cause mortality risk after principal component analysis (HR, 0.498 [95% CI, 0.313–0.791], P =0.003). Conclusions Nontraditional lipid parameters, especially Castelli’s index‐II may serve as a new AIS prognostic outcomes indicator. Constructed composite principal component analysis score for lipids was associated with all‐cause mortality at 1 year.