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This gap underscores the need to clarify the relationship between serum lipids and hemorrhagic stroke (HS) risk in a broader community-based population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed, Ovid, and the Cochrane Library were searched from inception to May 21, 2025, for observational prospective cohorts in populations with no major disease, baseline serum lipid assessment, and first-attack HS. Risk ratios (RRs) with 95% confidence intervals (95% CIs) of continuous variables and dose-response modeling were both analyzed. Potential nonlinear trends were validated through model comparison.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 50,244,342 participants from 54 cohorts were included. Continuous variable analysis revealed that serum total cholesterol (sTC) was inversely related to total HS (RR\u2009=\u20090.94, 95% CI 0.90\u2009~\u20090.97,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.01) and intracerebral hemorrhage (ICH) (RR\u2009=\u20090.90, 95% CI 0.87\u2009~\u20090.93,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.01) risk; serum low-density lipoprotein cholesterol (sLDL-C) was inversely related to total HS (RR\u2009=\u20090.92, 95% CI 0.86\u2009~\u20090.98,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.012) and ICH (RR\u2009=\u20090.83, 95% CI 0.74\u2009~\u20090.94,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.01) risk; and serum high-density lipoprotein cholesterol (sHDL-C) was inversely related to subarachnoid hemorrhage (SAH) (RR\u2009=\u20090.77, 95% CI 0.63\u2009~\u20090.92,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.01) risk. In the dose-response analysis, linear trends were detected in total HS, with a decreasing risk of 7.8% (95% CI 3.6%~11.8%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.01) per mmol\/L sTC increase and a decreasing risk of 9.6% (95% CI 2.4%~16.2%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.01) per mmol\/L sLDL-C increase; in ICH, with a decreasing risk of 17.0% (95% CI 7.5%~25.6%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.01) per mmol\/L sLDL-C increase; and in SAH, with a decreasing risk of 20.7% (95% CI 1.5%~36.1%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.036) per mmol\/L sHDL-C increase and a decreasing risk of 54.0% (95% CI 5.5%~77.6%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.035) per mmol\/L triglyceride increase. U-shaped trends were detected between sTC and ICH risk, with the lowest RR at 6.07 mmol\/L; between sLDL-C and SAH risk, with a minimum RR of 3.69 mmol\/L; between sHDL-C and total HS risk, with a minimum RR of 1.53 mmol\/L; and between sHDL-C and ICH risk, with a minimum RR of 1.50 mmol\/L.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>When the minimal important difference was set at an RR of 0.87\u2009~\u20091.15, sTC between 3.48\u2009~\u20095.20 mmol\/L, sLDL-C between 1.09\u2009~\u20093.40 mmol\/L, and sHDL-C between 0.99\u2009~\u20092.34 mmol\/L might provide balanced lipid management, contributing to stroke prevention in global community-based populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>The protocol of this study was registered on PROSPERO (CRD420250650371).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12944-025-02698-0","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T12:39:16Z","timestamp":1759235956000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Relationship between serum lipids and the risk of hemorrhagic stroke: a meta-analysis of 50\u00a0million participants from prospective cohort studies"],"prefix":"10.1186","volume":"24","author":[{"given":"Xuefan","family":"Yao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Houlin","family":"Lai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kehui","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benke","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aini","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haiqing","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,30]]},"reference":[{"issue":"10","key":"2698_CR1","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1016\/S1474-4422(21)00252-0","volume":"20","author":"GBDS Collaborators","year":"2021","unstructured":"Collaborators GBDS. 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