The impact of pre-diabetes and dyslipidemia on outcomes in ischemic stroke patients treated with tissue plasminogen activator: A cohort study

<title>Abstract</title> <p>Background Pre-diabetes (Pre-DM) and diabetes mellitus (DM) are common metabolic disorders that increase the risk of cardiovascular diseases, including acute ischemic stroke (AIS). While DM is well-known to worsen stroke outcomes, the impact of pre-DM on AIS patients treated with tissue plasminogen activator (tPA) remains unclear. This study investigates the prognostic factors affecting outcomes in pre-diabetic AIS patients who received tPA therapy. Methods A retrospective study was conducted involving 327 AIS patients treated with tPA between 2020 and 2024 at a tertiary general hospital. Patients were grouped as normoglycemic, pre-diabetic, or diabetic based on HbA1c levels. Clinical, laboratory, and outcome data, including the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS), were collected. Logistic regression analyses identified factors associated with favorable outcomes (defined as an mRS score of 0–2 at 3 months). Results The prevalence of hypertension increased progressively from the normoglycemic to the pre-diabetic to the diabetic groups (65.1% vs. 56.5% vs. 41.5%; P = 0.002). Dyslipidemia significantly worsened outcomes in pre-diabetic patients treated with tPA (aOR 0.277, 95% CI 0.093–0.827; P = 0.021), while its effect was less apparent in diabetic patients. In the pre-DM group, age and female sex were independently associated with better outcomes Conclusions Pre-DM is an intermediate cardiovascular risk state that worsens stroke outcomes and warrants clinical attention. Dyslipidemia critically impacts prognosis in tPA-treated pre-DM patients. Early assessment and targeted intervention for glycemic control and lipid abnormalities in pre-DM may improve functional recovery after AIS.</p>