High-Density Lipoprotein Is Associated with Progression of Intracranial Aneurysms

Background We tested the hypothesis that high-density lipoprotein (HDL) is associated with intracranial aneurysm growth and rupture. Methods We used an observational cohort study design. Age, sex, admission systolic blood pressure (SBP), diabetes, hypertension, coronary artery disease, aneurysmal rupture, apolipoprotein (APO)-A1, APO-B, HDL, low-density lipoprotein, triglycerides, cholesterol, and aneurysm location and size were recorded. Aneurysms Results The data from 581 patients with intracranial aneurysms were analyzed. The predictive factors for small size of aneurysms were female sex (odds ratio [OR], 0.630; 95% confidence interval [CI], 0.428–0.927; P = 0.019) and higher HDL (OR, 0.327; 95% CI, 0.159–0.672; P = 0.0002). In the subgroup of male patients, lower HDL was the only risk factor for large size (P = 0.015). The predictors of aneurysmal rupture were small size (OR, 0.875; 95% CI, 0.842–0.910; P = 0.000), higher HDL (OR, 3.716; 95% CI, 1.623–8.509; P = 0.002), no coronary artery disease (OR, 4.736; 95% CI, 1.528–14.681; P = 0.007), lower APO-A1 (OR, 0.202; 95% CI, 0.064–0.641; P = 0.007), and higher admission SBP (OR, 1.024; 95% CI, 1.015–1.032; P = 0.000). An HDL/aneurysm size ratio >0.31 was associated with a 46.2-fold increased likelihood of aneurysmal rupture (OR, 46.214; 95% CI, 13.386–159.548; P = 0.002). Conclusions The HDL level was inversely associated with intracranial aneurysm growth, especially in men. Higher HDL levels and small aneurysm size contributed to a greater risk of aneurysmal rupture. An HDL/size ratio >0.31 was a valuable predictor of intracranial rupture.