Background: Post-stroke epilepsy (PSE) is a common complication after ischemic stroke (IS) that worsens prognosis and quality of life. The atherogenic index of plasma (AIP) is an emerging biomarker for cardiovascular and metabolic diseases, but its link with PSE is unknown. Objective: This study aimed to evaluate the association between AIP and the risk of PSE in patients with IS. Design: A multicenter retrospective cohort study. Methods: We analyzed data from 21,459 IS patients in Southwest China (2017–2023). AIP was calculated as log10(triglycerides/high-density lipoprotein cholesterol) from baseline lipid profiles. The primary outcome was PSE occurrence within 1 year post-stroke. The relationship between AIP and PSE was assessed using multivariable logistic regression and restricted cubic spline (RCS) models, adjusting for demographic, clinical, and laboratory covariates. Subgroup and sensitivity analyses were performed to test robustness. Results: Among 21,459 participants, 936 (4.36%) developed PSE. Higher AIP levels were significantly associated with increased PSE risk. After full adjustment, each 1-standard deviation increase in AIP was associated with a 1.56-fold higher PSE risk (odds ratio = 1.56; 95% confidence interval: 1.44–1.68). Patients in the highest AIP quartile ( Q 4) had a 3.89-fold increased risk compared to the lowest quartile ( Q 1). RCS analysis revealed a nonlinear dose-response relationship, with an inflection point at AIP = 0.193. Subgroup analyses indicated stronger associations in patients without diabetes, coronary artery disease, or specific subcortical lesions. Conclusion: Elevated AIP is independently associated with an increased risk of PSE in IS patients, following a nonlinear dose-response pattern. AIP may serve as a valuable clinical tool for PSE risk stratification, facilitating early identification and preventive management. Prospective studies are warranted for validation.
Wan et al. (Sun,) studied this question.