This study examined the association between non-high-density lipoprotein cholesterol (Non-HDL-C) and hemorrhagic transformation (HT) in acute ischemic stroke (AIS) patients.

In all, 1349 patients were included (median age 64.16 years; 63.5% male). HT occurred in 139 patients (10.3%). The incidence of HT significantly decreased across increasing tertiles of Non-HDL-C (P = 0.007), whereas there was no significant change across increasing tertiles of LDL-C (P = 0.129). In a logistic regression analysis adjusted for age, gender, NIHSS on admission, atrial fibrillation, smoking, alcohol consumption and TOAST classification, patients with Non-HDL-C < 2.60 mmol/L had a higher risk of HT (OR 1.63, 95CI 1.01-2.62, P = 0.045) compared to that of those with Non-HDL-C > 3.47 mmol/L. However, there was no significant difference in HT between patients with LDL-C < 2.18 mmol/L and those with LDL-C > 2.95 mmol/L (OR 1.34, 95CI 0.84-2.15, P = 0.215).

Low Non-HDL-C is independently associated with HT. Non-HDL-C appears to be a better marker of the risk of HT than LDL-C. Therapies associated with a risk of bleeding should be used carefully in acute ischemic stroke.