MHR and AIP as Differential Predictors of 1-Year Major Adverse Cardiovascular and Cerebrovascular Events After Acute Ischemic Stroke: A Combined Model Study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Objective: To evaluate the predictive value of monocyte-to-high-density lipoprotein cholesterol ratio (MHR), plasma atherogenic index (AIP), and baseline National Institutes of Health Stroke Scale (NIHSS) score for 1-year major adverse cardiovascular and cerebrovascular events (MACCE) after acute ischemic stroke, and to explore potential differences in their predictive patterns across endpoint subtypes. Methods: This retrospective study enrolled 429 elderly patients (≥65 years) with acute ischemic stroke admitted to Lu'an People's Hospital (Anhui, China) between January 2020 and September 2023. Clinical and laboratory data were collected; MHR and AIP were Z-standardized. Patients were followed for 1 year for MACCE (stroke recurrence, all-cause mortality, non-fatal myocardial infarction/angina). Independent predictors were identified using multivariable logistic regression (Enter method: full model, then parsimonious model). Receiver operating characteristic (ROC) curves and DeLong tests compared individual and combined (MHR+AIP+baseline NIHSS) models. Endpoint-specific analyses were exploratory. Bootstrap resampling was performed for internal validation. Results: MACCE occurred in 115 patients (26.8%), comprising 58 stroke recurrences, 41 deaths, and 17 coronary events. MHR (per 1-SD increase: OR=2.765, 95% CI: 2.062-3.707, P<0.001), AIP (per 1-SD increase: OR=1.682, 95% CI: 1.289-2.193, P<0.001), and Baseline NIHSS score (OR=1.170, 95% CI: 1.108-1.235, P<0.001) were independent predictors of MACCE. In exploratory endpoint-specific analyses, MHR was associated with all three subtypes, while AIP was associated with stroke recurrence and coronary events but not all-cause mortality. However, formal interaction tests were underpowered. AUCs were 0.731 (MHR), 0.628 (AIP), 0.646 (NIHSS), and 0.810 (combined); the combined model outperformed all individual markers (all P<0.05 by DeLong test). Conclusion: MHR and AIP independently predict 1-year MACCE in elderly stroke patients. The observed differences in their associations across endpoint subtypes are exploratory and hypothesis-generating; formal interaction tests or adequately powered prospective studies are required. The combined model may improve risk stratification, but requires prospective validation.
Source: Clinical Interventions in Aging
DOI: 10.2147/cia.s622634
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,836
OpenAlex ID: W7224181311