U-shaped Relationship between high-density lipoprotein cholesterol levels and intracranial aneurysm rupture: a retrospective cross-sectional study in the Chinese population.

Abstract

Background: Previous results on the association between HDL (high-density lipoprotein cholesterol) levels and intracranial aneurysm (IA) rupture were controversial. We aimed to investigate the association between HDL levels and the risk of IA rupture.

Methods: Medical records of patients with solitary IA diagnosed at West China Hospital of Sichuan University were reviewed and analyzed between December 2008 and March 2023. Univariable and multivariable logistic regression analyses were performed to determine the effects of HDL levels on IA rupture risk. A three-piece-wise logistic regression model with smoothing was used to analyze different association thresholds between HDL and the risk of IA rupture after adjusting for confounding factors.

Results: Univariable and multivariable logistic regression analysis showed the independent association between HDL and IA rupture. After being adjusted for confounders, different U-shaped relationships were found between HDL levels and the risk of IA in males, females, and all patients. Compared to HDL in the range of 0.9 ~ 1.3 mmol/L, patients had 79% [OR (95%CI):1.79(1.16 ~ 2.78), p = 0.009] increase of rupture when lower than 0.9 mmol/L, 60% [OR (95%CI):1.6(1.19 ~ 2.17), p = 0.002] increase when higher than 1.3 mmol/L before or after adjusted confounders. We found gender differences in the HDL range of IA rupture; the lowest range of HDL was 1.1 ~ 1.4 mmol/L in females and 0.8 ~ 1.1 mmol/L in males.

Conclusions: There was a U-shaped relationship between HDL levels and the risk of IA rupture. People with HDL levels between 0.9 and 1.3 mmol/L are least likely to experience IA rupture in the Chinese population.