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.