Lipid feature and late onset ≥80 years of ischemic stroke: a retrospective study in lipid-lowering therapy-naive adults.

BACKGROUND: The population of patients with first-onset ischemic stroke at or above the age of 80 is steadily growing. However, the distinct lipid profile characteristics of this oldest-old cohort remain systematically undefined. This study aimed to delineate these lipid patterns and elucidate their association with the late onset of acute ischemic stroke in advanced age.

METHODS: We conducted a retrospective cohort analysis of patients with first-ever acute ischemic stroke consecutively enrolled between March 2022 and June 2025. To mitigate confounding by lipid-lowering therapies, a critical modifier of both lipid metabolism and cerebrovascular risk, we implemented strict exclusion criteria for any prior exposure to cholesterol-modulating agents. Participants were stratified into three age groups: youngest-old (60-69 years), middle-old (70-79 years), and oldest-old (≥80 years). Demographic characteristics and lipid parameters were systematically analyzed across groups, with correlation and multivariate regression analyses performed to identify lipid-related predictors of late-onset ischemic stroke.

RESULTS: A total of 565 patients were included in the final analysis based on our inclusion and exclusion criteria (239 youngest-old; 200 middle-old; 126 oldest-old). The oldest-old group exhibited significantly lower levels of total cholesterol, triglycerides, apolipoprotein B, low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), and reduced LDL-C/HDL-C and VLDL-C/HDL-C ratios compared to younger cohorts (all p < 0.05). Additionally, this group demonstrated decreased prevalence rates of dyslipidemia subtypes, particularly for total cholesterol, triglycerides, LDL-C, and VLDL-C abnormalities. Notably, 11 distinct patterns of combined dyslipidemia showed diminished frequency in the oldest-old. Multivariate analysis identified non-HDL-C as the strongest lipid predictor of late-onset ischemic stroke in the overall population, with gender-specific variations: LDL-C emerged as the primary contributor in females, whereas triglycerides showed predominant association in males.

CONCLUSION: The findings suggest a distinct lipid profile in older adults with late-onset ischemic stroke. A key implication for management is that non-HDL-C should be elevated to a co-primary target alongside LDL-C in public health strategies for lipid control.