Prediction of recurrent acute Ischemic Stroke based on Apolipoprotein B levels: a nested case-control study​

Background Mendelian randomization studies have identified that apolipoprotein B (ApoB) is the primary genetic determinant of ischemic stroke, rather than other lipid markers. However, its predictive value for the recurrence of non-cardioembolic acute ischemic stroke (AIS) remains unclear. This study aims to investigate this association. Methods This study recruited 578 patients with acute ischemic stroke, excluding those with cardiogenic embolism. After a 3-year follow-up, a total of 428 patients completed the prospective cohort study. A Cox regression model was used to evaluate the association between ApoB levels at admission and the recurrence rate. Additionally, a nested case-control study was conducted by comparing blood samples collected at the time of recurrence from recurrent patients with those from non-recurrent patients. Binary logistic regression and ROC curve analysis were used to assess the association between serum ApoB, LDL-C, and stroke recurrence at the time of recurrence. Results The Cox regression model demonstrated that ApoB levels upon admission were an independent predictor of stroke recurrence (HR=6.697; 95% CI: 2.581-17.374, P<0.001). Patients with recurrent strokes exhibited significantly higher serum ApoB levels at admission compared to those without recurrence [0.85 g/L (IQR=0.21) vs. 0.63 g/L (IQR=0.15)]. In the ROC receiver curve, ApoB demonstrated a higher ability to identify stroke recurrence compared with LDL-C (AUC=0.732). Conclusion Higher serum ApoB levels increase the risk of recurrence in patients with non-cardiac AIS, and ApoB has demonstrated better predictive value compared with LDL-C after drug therapy. These findings suggest that routine ApoB measurement may optimize secondary stroke prevention.