Cumulative association of triglycerides and interleukin-6 with recurrent vascular events after ischemic stroke

Despite guideline-directed low-density lipoprotein cholesterol (LDL-C) lowering, substantial residual vascular risk persists after stroke. Triglycerides (TG) and interleukin-6 (IL-6) have each been linked to this risk, yet their joint prognostic effect remains unclear.

To evaluate the cumulative prognostic association of baseline TG and IL-6 levels with the risk of recurrent vascular events after stroke.

We analyzed 962 consecutive patients (mean age, 71.0 years; male, 61.1%) with ischemic stroke or transient ischemic attack enrolled within 1 week of onset in a prospective observational study. TG levels were dichotomized at 150 mg/dL, and IL-6 levels at the median of 4.0 pg/mL. Patients were classified as LL (low TG/low IL-6), HL (high TG/low IL-6), LH (low TG/high IL-6), and HH (high TG/high IL-6) groups. The primary endpoint was 1-year major adverse cardiovascular events (MACE), defined as recurrent stroke, acute coronary syndrome, or vascular death.

Both TG ≥ 150 mg/dL and IL-6 ≥ 4.0 pg/mL were independently associated with an increased risk of MACE. Annual MACE rates increased across the 4 categories: 8.0%, 17.5%, 15.7%, and 23.8% in the LL, HL, LH, and HH groups, respectively (log-rank P = .001). Compared with LL, both HL (hazard ratio [HR], 2.12; 95% CI 1.18-3.80) and LH (HR, 1.71; 95% CI 1.05-2.77) had significantly higher risk, with HH showing the highest risk (HR, 2.43; 95% CI 1.40-4.23). Notably, this cumulative association remained consistent in patients with atherothrombotic stroke, those receiving statin therapy, and those with LDL-C levels <100 mg/dL or <70 mg/dL.

Stratification by TG and IL-6 levels revealed a cumulative increase in MACE risk after stroke, with the highest risk in patients with a dual burden of hypertriglyceridemia and systemic inflammation.