BMI modifies the association between serum HDL cholesterol and stroke in a hypertensive population without atrial...

Both high-density lipoprotein cholesterol (HDL-C) and body mass index (BMI) have an impact on the prevalence of stroke. However, it is unclear whether BMI can modify the relationship between HDL-C and stroke. Therefore, we aimed to assess the effect of the BMI on the association between HDL-C and stroke in a hypertensive population without atrial fibrillation (AF).

We analyzed data of 10,925 hypertensive patients without AF from the Chinese Hypertension Registry Study. BMI was categorized as < 24 and ≥ 24 kg/m². Multivariate logistic regression and smooth curve fitting (penalized spline method) were used to analyze the association between HDL-C and stroke in different BMI groups. Subgroup analysis and interaction tests were used to explore the effect of other variables on this relationship.

The results showed a negative association between HDL-C and stroke in the BMI < 24 kg/m² group, but HDL-C was not associated with stroke in the BMI ≥ 24 kg/m² group. In the BMI < 24 kg/m² group, each 1 mmol/L increase in HDL-C was associated with a 50% decreased risk of stroke [odds ratio (OR) 0.50, 95% confidence interval (CI) 0.38-0.66]. No significant relationship between HDL-C and stroke was observed in the BMI ≥ 24 kg/m² group (OR 0.73, 95% CI 0.49-1.10). There was a significant interaction between BMI and HDL-C in regard to the prevalence of stroke in the hypertensive population without AF (P_Interaction = 0.027).

We found an inverse association between HDL-C and stroke only in the BMI < 24 kg/m² group. The finding suggested that BMI could modify the association between HDL-C and stroke in hypertensive populations without AF.