Non-traditional lipid-inflammatory parameters estimate the risk of stroke in middle-aged and older Chinese adults: a nationwide prospective cohort study

BACKGROUND: Non-traditional lipid parameters demonstrate cardiovascular predictive value, yet their interaction with inflammatory markers in stroke risk assessment remains understudied. This research investigated their independent and combined effects on stroke risk in a nationally representative cohort, while comparing their predictive capability with traditional lipid parameters. METHODS: The study cohort comprised 9,236 individuals aged ≥45 years, derived from the China Health and Retirement Longitudinal Study (CHARLS), with self-reported stroke as the primary outcome. Non-traditional lipid parameters were combined with High-sensitivity C-reactive protein (hs-CRP) to create lipid-inflammatory indices. Cox proportional hazards models and restricted cubic spline regression assessed stroke risk associations. Mediation analysis examined relationships between hs-CRP, lipid parameters, and stroke. RESULTS: During the 7-year follow-up, 664 participants developed stroke. The incidence of stroke increased with increasing quartiles of non-traditional lipid parameters. In fully adjusted models, participants with higher baseline and cumulative levels of non-traditional lipid parameters had the highest risk of stroke, with consistent results across non-traditional lipid inflammation parameters, especially in AIP-CRP (HR = 1.98, 95 % CI: 1.56-2.50). Non-traditional lipid inflammation parameters showed better predictive ability compared with individual parameters, and the results remained robust in subgroup and sensitivity analyses. Mediation analysis established bidirectional mediating effects between non-traditional lipid parameters, hs-CRP, and stroke risk. CONCLUSIONS: Non-traditional lipid parameters are significantly associated with increased stroke risk in middle-aged and older Chinese adults, with combined lipid-inflammatory markers demonstrating superior predictive value. These findings underscore the importance of integrating both non-traditional lipid parameters and inflammatory markers for comprehensive stroke risk assessment.