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<p>The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is a novel lipid indicator for predicting mortality across populations, but its link to mortality in the general population is underestimated. A total of 17,334 participants from the US National Health and Nutrition Examination Survey (2005–2018) were analyzed. Weighted Cox proportional hazards models were employed to investigate the association between NHHR and all-cause and cardiovascular (CVD) mortality. We employed restricted cubic splines (RCS) to assess potential nonlinear relationships. Over a median follow-up of 88&#xa0;months, we documented 1878 deaths. According to the RCS analysis, NHHR exhibited an L-shaped association with all-cause and CVD mortality. Inflection points were identified at NHHR = 2.30 for all-cause mortality and NHHR = 2.64 for CVD mortality. Below these thresholds, each unit increase in NHHR was associated with a 39% reduction in all-cause mortality (HR: 0.61, 95% CI 0.50–0.75) and a 34% reduction in CVD mortality (HR: 0.66, 95% CI 0.50–0.88). Above these thresholds, no significant associations were observed. Subgroup analyses revealed stronger inverse associations in adults aged ≥ 60&#xa0;years (<i>P</i> for interaction &lt; 0.0001) and those with underweight or overweight statuses (<i>P</i> = 0.0032). Our findings highlight an L-shaped association between NHHR and both all-cause and cardiovascular disease (CVD) mortality. NHHR demonstrates potential as a novel biomarker for personalized mortality risk stratification, particularly in high-risk subgroups.</p>

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Associations of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio with all-cause and cardiovascular mortality among general population

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  • 发表日期：

    2025年12月17日

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  • Songfeng Zhao,
  • Liqiaona Fan

摘要

The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is a novel lipid indicator for predicting mortality across populations, but its link to mortality in the general population is underestimated. A total of 17,334 participants from the US National Health and Nutrition Examination Survey (2005–2018) were analyzed. Weighted Cox proportional hazards models were employed to investigate the association between NHHR and all-cause and cardiovascular (CVD) mortality. We employed restricted cubic splines (RCS) to assess potential nonlinear relationships. Over a median follow-up of 88 months, we documented 1878 deaths. According to the RCS analysis, NHHR exhibited an L-shaped association with all-cause and CVD mortality. Inflection points were identified at NHHR = 2.30 for all-cause mortality and NHHR = 2.64 for CVD mortality. Below these thresholds, each unit increase in NHHR was associated with a 39% reduction in all-cause mortality (HR: 0.61, 95% CI 0.50–0.75) and a 34% reduction in CVD mortality (HR: 0.66, 95% CI 0.50–0.88). Above these thresholds, no significant associations were observed. Subgroup analyses revealed stronger inverse associations in adults aged ≥ 60 years (P for interaction < 0.0001) and those with underweight or overweight statuses (P = 0.0032). Our findings highlight an L-shaped association between NHHR and both all-cause and cardiovascular disease (CVD) mortality. NHHR demonstrates potential as a novel biomarker for personalized mortality risk stratification, particularly in high-risk subgroups.