Aims: C-reactive protein is an established marker of inflammation that can impair the
protective function of High Density Lipoprotein Cholesterol (HDL-C). The combined effect of Creactive
protein and HDL-C on long-term outcomes in patients with stroke remains uncertain.
Methods: A total of 3124 acute ischemic stroke subjects from the China Antihypertensive Trial in
Acute Ischemic Stroke (CATIS) were included in this analysis. Participants were divided into four
groups according to CRP and HDL-C levels on admission. The primary outcome was a combination
of death and major disability (modified Rankin Scale score ≥3) at one year after stroke.
Results: Compared to participants with low CRP/ high HDL-C, adjusted odd ratios for primary
outcome for those with low CRP /low HDL-C, high CRP /high HDL-C and high CRP /low HDL-C
were 1.06(0.81-1.39),1.78(1.31-2.41) and 2.03(1.46-2.80), respectively, after multiple adjustments.
Adding serum CRP and HDL-C status to a model containing conventional stroke risk factors significantly
improve risk reclassification for the combined outcome of death and major disability
(NRI: 6.85%, P=0.005; IDI: 2.57%, P=0.002). Moreover, no interaction was observed between
CRP and HDL-C in relation to stroke outcomes (P-interaction >0.05 for all).
Conclusions: High CRP with low HDL-C levels was associated with death and major disability
within one year after ischemic stroke. The findings suggest that the ischemic patients with both
high CRP and low HDL-C should be treated with reducing CRP and promoting HDL-C levels.