ArticleTranslational stroke research2026
Age-Related Brain Atrophy Mediates a Composite Outcome of One-Year Ischemic Stroke Recurrence and All-Cause Mortality Through YKL-40-Related Inflammatory Pathways: A Structural Equation Model.
Article in Translational stroke research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Chronological age is a strong predictor of poor outcomes after ischemic stroke but may not fully capture underlying biological vulnerability. This study investigated whether age-related brain atrophy and plasma YKL-40, a marker of astroglial inflammation, mediate the association between age and the one-year risk of ischemic stroke recurrence or all-cause mortality. Data were obtained from 4,305 participants enrolled in the Third China National Stroke Registry. Baseline brain atrophy was quantified from structural T1-weighted MRI using an automated deep learning-based pipeline (FastSurfer), yielding hemispheric cortical and white matter volumes that were modeled as indicators of a latent atrophy construct. Structural equation modeling was applied to estimate direct and indirect pathways linking age, brain atrophy, YKL-40, and one-year composite outcomes, adjusting for sex, atrial fibrillation or flutter, hypertension, and diabetes, with indirect effects evaluated using 5,000 bootstrap resamples. The total effect of age on one-year outcomes was not significant (β = -0.011; 95% CI, - 0.060 to 0.038), whereas the total indirect effect was significant (β = 0.028; 95% CI, 0.005-0.050). Mediation was primarily attributable to YKL-40 (β = 0.026; 95% CI, 0.010-0.041), while the independent contribution of brain atrophy was minimal. The indirect effects accounted for approximately 255% of the total effect, indicating a suppressor-type mediation pattern in which direct and indirect effects operated in opposite directions. These findings suggest that advancing age confers increased long-term risk of stroke recurrence or death predominantly through astroglial inflammation rather than through a direct age effect, with brain atrophy modestly amplifying this risk, supporting the integration of neuroimaging and inflammatory biomarkers into translational stroke risk stratification.
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