Atherogenic index of plasma as a predictor of hounsfield unit attenuation, infarct lesion number, and stroke severity in acute ischemic stroke

Atherogenic index of plasma as a predictor of hounsfield unit attenuation, infarct lesion number, and stroke severity in acute ischemic stroke

Authors

  • Arifian Wijaya Lana Putra Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
  • Muhammad Yunus Amran Division of Interventional Neurology and Neuroendovascular Therapy, Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Brain Centre, Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia; Hasanuddin University Teaching Hospital, Makassar, Indonesia https://orcid.org/0000-0001-5079-7490
  • Mimi Lotisna Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
  • Irfan Idris Department of Physiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia https://orcid.org/0000-0002-7350-8687
  • Muhammad Akbar Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Brain Centre, Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia ; Hasanuddin University Teaching Hospital, Makassar, Indonesia
  • Andi Weri Sompa Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia

Keywords:

atherogenic index of plasma, hounsfield unit, cerebral lesion, ischemic stroke

Abstract

Background and aim: The triglyceride (TG)/high-density lipoprotein (HDL) cholesterol Log (TG/HDL-C) ratio is characterized as the serum atherogenic indeks of plasma (AIP). A high TG/HDL-C ratio is associated with vascular conditions, insulin resistance, and metabolic syndrome. Cerebrovascular diseases have recognized the importance of the lipid profile linked to AIP. However, there are still relatively few studies exploring the AIP in relation to these conditions, especially ischaemic stroke (IS). This study aim to find out the association between AIP with Hounsfield unit (HU), CT (Computed Tomography) cerebral lesion burden and neurological impairment in IS.

Methods: Patients with acute ischemic stroke (AIS) admitted between January until December 2023 were retrospectively enrolled in this study. The AIP was determined using the subsequent formula derived from blood test: AIP=log [TG (mg/dL)/HDL cholesterol (mg/dL)]. AIP was classified into low risk (<0.11), moderate risk (0.11-0.21), high risk (>0.21). Statistical analysis was processed with SPSS version 26.0 software, presented in frequency distribution tables, and discussed.

Results: 103 AIS patients, average age was 60.20 years, with 51 females (49,5%) and 52 males (50,5%). The Association between AIP and CT cerebral lesion burden, as well as neurological impairment using National Institutes of Health Stroke Scale (NIHSS) score, is statistically significant with a positive relationship with HU (acute phase) r=+0.612; p<0.001, CT cerebral lesions and neurological impairment, respectively r= +0.825; p<0.001 and r=+0.602; p<0.001.

Conclusions: This study demonstrates a significant association between high serum AIP with HU (acute phase), multiple CT cerebral lesions and severe neurological impairment of ischemic stroke. This simple, inexpensive and effective test method can prevent the occurrence of ischemic stroke. (www.actabiomedica.it)

Author Biographies

Arifian Wijaya Lana Putra, Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia

Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia

Muhammad Yunus Amran, Division of Interventional Neurology and Neuroendovascular Therapy, Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Brain Centre, Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia; Hasanuddin University Teaching Hospital, Makassar, Indonesia

Division of Interventional Neurology and Neuroendovascular Therapy, Department of Neurology, Faculty of Medicine,   Hasanuddin University, Makassar, Indonesia
Brain Centre, Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia
Hasanuddin University Teaching Hospital, Makassar, Indonesia

Mimi Lotisna, Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia

Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia

Irfan Idris, Department of Physiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia

Department of Physiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia

Muhammad Akbar, Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Brain Centre, Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia ; Hasanuddin University Teaching Hospital, Makassar, Indonesia

Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
Brain Centre, Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia
Hasanuddin University Teaching Hospital, Makassar, Indonesia

Andi Weri Sompa, Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia

Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia

References

1. World Health Organization. The WHO STEPwise approach to stroke surveillance. Geneva: World Health Organization; 2006. Available from: https://apps.who.int/iris/handle/10665/43420

2. Bowman TS, Sesso HD, Ma J, et al. Cholesterol and the risk of ischemic stroke. Stroke. 2003;34(12):2930–4. doi:10.1161/01.STR.0000102171.91292.DC

3. Donkor ES. Stroke in the 21st century: a snapshot of the burden, epidemiology, and quality of life. Stroke Res Treat. 2018;2018:3238165. doi:10.1155/2018/3238165

4. Aslan M, Okşen D, Yavuz YE, Kaynak Ç. Atherogenic plasma index is associated with ischemic cerebrovascular events due to carotid artery disease. Anatol Curr Med J. 2024;6(3):198–202. doi:10.38053/acmj.1448539

5. Venketasubramanian N, Yoon BW, Pandian J, Navarro JC. Stroke Epidemiology in South, East, and South-East Asia: A Review [published correction appears in J Stroke. 2018 Jan;20(1):142. doi: 10.5853/jos.2017.00234.e1.]. J Stroke. 2017;19(3):286-294. doi:10.5853/jos.2017.00234

6. Jebari-Benslaiman S, Galicia-García U, Larrea-Sebal A, et al. Pathophysiology of atherosclerosis. Int J Mol Sci. 2022;23(6):3346. doi:10.3390/ijms23063346

7. Çelik E, Çora AR, Karadem KB. The effect of untraditional lipid parameters in the development of coronary artery disease: atherogenic index of plasma, atherogenic coefficient and lipoprotein combined index. J Saudi Heart Assoc. 2021;33(3):244–50. doi:10.37616/2212-5043.1266

8. Amran MY, Punala Putra NMM, Muhlizah Nurhikmah SAR, Helariani Panti DS, Gunadi SGA. Comparative analysis of serum lipid profiles in ischemic and hemorrhagic stroke: a retrospective cross-sectional study. Acta Biomed. 2025;96(3):17156. doi:10.23750/abm.v96i3.17156

9. Liu H, Liu K, Pei L, et al. Atherogenic index of plasma predicts outcomes in acute ischemic stroke. Front Neurol. 2021;12:741754. doi:10.3389/fneur.2021.741754

10. Sulistiowati E, Sihombing M. NCEP-ATP III and IDF criteria for metabolic syndrome predict type 2 diabetes mellitus. Univ Med. 2016;35(1):46–55. doi:10.18051/UnivMed.2016.v35.46-55

11. Šebeková K, Gurecká R, Šebek J, Šebeková L. Atherogenic index of plasma – a novel, simple and cost-effective predictor of cardiovascular risk in primary and secondary prevention. Vnitr Lek. 2023;69(1):24–30. PMID: 36714901

12. Govind AS, Sukumar S, Dkhar W. Grading of cerebral infarction using CT-Hounsfield unit to report the Hounsfield unit in acute, subacute and chronic stroke. Int J Curr Res. 2015;7(3):13537–9

13. Zhu Z, Zhang R, Ren K, et al. The prognosis prediction significance of Hounsfield unit value for stroke patients treated by intravenous thrombolysis. BMC Med Imaging. 2021;21(1):62. doi:10.1186/s12880-021-00592-6

14. Payabvash S, Taleb S, Benson JC, McKinney AM. Acute ischemic stroke infarct topology: association with lesion volume and severity of symptoms at admission and discharge. AJNR Am J Neuroradiol. 2017;38(1):58–63. doi:10.3174/ajnr.A4970

15. Farooque U, Lohano AK, Kumar A, et al. Validity of National Institutes of Health Stroke Scale for severity of stroke to predict mortality among patients presenting with symptoms of stroke. Cureus. 2020;12(7):e10255. doi:10.7759/cureus.10255

16. Rajashekar D, Wilms M, MacDonald ME, et al. Lesion-symptom mapping with NIHSS sub-scores in ischemic stroke patients. Stroke Vasc Neurol. 2022;7(2):124–31. doi:10.1136/svn-2021-001091

17. Zöllner JP, Misselwitz B, Kaps M, et al. National Institutes of Health Stroke Scale (NIHSS) on admission predicts acute symptomatic seizure risk in ischemic stroke: a population-based study involving 135,117 cases. doi:10.1038/s41598-020-60628-9

18. Nam JS, Kim MK, Nam JY, et al. Association between atherogenic index of plasma and coronary artery calcification progression in Korean adults. Lipids Health Dis. 2020;19(1):157. doi:10.1186/s12944-020-01317-4

19. Amran MY, Hidayah M, Akbar M, et al. Hounsfield unit-to-hematocrit ratio as a quantitative marker for cerebral venous sinus thrombosis: a retrospective diagnostic study. Acta Biomed. 2025;96(4):16843. doi:10.23750/abm.v96i4.16843

20. Pande SD, Garg R, Joshi D, et al. Profile of stroke patients at a tertiary care center in North India. J Family Med Prim Care. 2022;11(3):1390–6. doi:10.4103/jfmpc.jfmpc_1641_21

21. Bai X, Li Z, Cai Z, et al. Gender differences in risk factors for ischemic stroke: a longitudinal cohort study in East China. BMC Neurol. 2024;24:171. doi:10.1186/s12883-024-03678-0

22. Nam KW, Kwon HM, Lee YS, et al. Atherogenic index of plasma predicts early recurrent ischemic lesions in acute ischemic stroke. J Neurosonol Neuroimag. 2022;14(1):29–35. doi:10.31728/jnn.2022.00049

23. Wang J, Chen F, Cui X, et al. Relationship between cumulative exposure to atherogenic index of plasma and incident ischemic stroke: results from the Kailuan Study. Cardiovasc Diabetol. 2023;22(1):212. doi:10.1186/s12933-023-02044-7

24. Alqahtani SA, Osman NM, Alghamdi MF, et al. Role of Hounsfield Unit measurement in noncontrast CT for predicting early ischemic changes in acute stroke. Eur Neurol. 2023;90(1–2):16–22

25. Arboix A, Alió J. Cardioembolic stroke: clinical features, specific cardiac disorders and prognosis. Curr Cardiol Rev. 2010 Aug;6(3):150-61. doi: 10.2174/157340310791658730

26. Rao C, Zhu L, Yu C, et al. Association of novel lipid indices with the white matter hyperintensities in cerebral small vessel disease: a cross-sectional study. Lipids Health Dis. 2024;23(1):333. doi:10.1186/s12944-024-02318-3

27. Ali B, Amir A, Ago JL, Khalid MI. Investigation of the association between computed tomography Hounsfield units and cerebral infarction phases: a cross-sectional study. 2025. doi:10.21203/rs.3.rs-5900395/v1

28. Khosravi A, Sadeghi M, Farsani ES, et al. Atherogenic index of plasma: A valuable novel index to distinguish patients with unstable atherogenic plaques. J Res Med Sci. 2022 Jun 30;27:45. doi: 10.4103/jrms.jrms_590_21

29. Wang L, Gill R, Pedersen TL, Higgins LJ, Newman JW, Rutledge JC. Triglyceride-rich lipoprotein lipolysis releases neutral and oxidized FFAs that induce endothelial cell inflammation. J Lipid Res. 2009 Feb;50(2):204-13. doi: 10.1194/jlr.M700505-JLR200

30. Clim A, Maranducă MA, Pînzariu AC, et al. Atherogenic index of plasma (AIP): can be a biomarker for early endothelial dysfunction and cardiovascular disease in experimental models of obesity rats? Rev Med Chir Soc Med Nat Iasi. 2024;128(2):290–303. doi:10.22551/MSJ.2024.02.11

31. Ahn SS, Lee LE, Pyo JY, Song JJ, Park YB, Lee SW. Atherogenic index of plasma predicts cerebrovascular accident occurrence in antineutrophil cytoplasmic antibody-associated vasculitis. Lipids Health Dis. 2020 Aug 14;19(1):184. doi: 10.1186/s12944-020-01360-1

32. Huang H, Yu X, Li L, et al. Atherogenic index of plasma is related to coronary atherosclerotic disease in elderly individuals: a cross-sectional study. Lipids Health Dis. 2021;20(1):68. Published 2021 Jul 11. doi:10.1186/s12944-021-01496-8

33. Aciman Demirel E, Kalaycı G, Açıkgöz M, Çelebi U, Cinar B, Atasoy HT. Evaluation of the Relationship between Silent Cerebral Lesions and Triglyceride/HDL-Cholesterol in Patients with First Stroke Attack. Duzce Med J. 2020;22(3):191-5. doi:10.18678/dtfd.737978

34. Kazi SA, Siddiqui M, Majid S. Stroke Outcome Prediction Using Admission Nihss In Anterior And Posterior Circulation Stroke. J Ayub Med Coll Abbottabad. 2021;33(2):274-8.

35. Lyden P, Lu M, Levine SR, Brott TG, Broderick J, NINDS rt‑PA Stroke Study Group. A modified National Institutes of Health Stroke Scale for use in stroke clinical trials: preliminary reliability and validity. Stroke. 2001;32(1):131‑7. doi:10.1161/01.STR.30.1.131

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Published

05-08-2025

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ORIGINAL CLINICAL RESEARCH

How to Cite

1.
Putra AWL, Amran MY, Lotisna M, Idris I, Akbar M, Sompa AW. Atherogenic index of plasma as a predictor of hounsfield unit attenuation, infarct lesion number, and stroke severity in acute ischemic stroke. Acta Biomed. 2025;96(4):17321. doi:10.23750/abm.v96i4.17321