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Background <p>The prognostic value of lipid metrics in atrial fibrillation (AF) recurrence following catheter ablation (CA) remains controversial. This study investigated the prognostic value of the non-high-density lipoprotein-cholesterol/high-density lipoprotein-cholesterol ratio (NHHR) in predicting postablation AF recurrence.</p> Methods <p>In this cohort study, 1,728 patients with AF undergoing first-time CA at our center (2017–2020) were stratified by NHHR quartiles (Q1–Q4). The primary endpoint was AF recurrence and the secondary endpoint was incidence of Major Adverse Cardiovascular and Cerebrovascular Events (MACCEs) following CA.</p> Results <p>A U-shaped association was observed between the NHHR and AF recurrence (P<sub>nonlinear</sub> = 0.021), with an inflection point at NHHR = 2.61, driven predominantly by an increased recurrence risk at lower NHHR values. Compared to the third quartile (Q3) (2.62–3.26), patients in the first NHHR quartile (Q1) had a 63.6% higher risk of recurrence (hazard ratio [HR] = 1.636, 95% confidence interval [CI]: 1.235–2.166). For NHHR &lt; 2.61, the risk of recurrence risk decreased with an adjusted HR of 0.715 (95% CI, 0.524–0.977, <i>P</i> = 0.035) for every one-unit increment in the NHHR. The association for NHHR values above the inflection point was not statistically significant. Subgroup analyses confirmed consistency across age, sex, AF subtypes and duration, diabetes mellitus, CHA<sub>2</sub>DS<sub>2</sub>-VA scores, left atrial diameter, and non-PVI lesions (P<sub>interaction</sub> &gt; 0.05). Sensitivity analysis further validated the temporal robustness of the association. NHHR demonstrated no association with MACCEs, underscoring its AF-specific prognostic value.</p> Conclusions <p>NHHR exhibited a U-shaped association with postablation AF recurrence, driven primarily by an increased risk at lower values. It may serve as a nonlinear lipid biomarker, with its role at the higher values requiring further investigation. Integration into clinical risk stratification is warranted, although therapeutic targeting requires additional mechanistic validation.</p> <p><i>Trial registration</i>: ChiCTR-OCH-14004674.</p>

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U-shaped association of non-HDL-C/HDL-C ratio with atrial fibrillation recurrence postcatheter ablation: a cohort study

  • 期刊论文

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  • 发表日期：

    2026年7月26日

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  • Mingjie Lin,
  • Naiyan Qiu,
  • Nan Yang,
  • Tongshuai Chen,
  • Bing Rong,
  • Wenqiang Han,
  • Maduray Kellina,
  • Jingquan Zhong,
  • Kai Zhang

摘要

Background

The prognostic value of lipid metrics in atrial fibrillation (AF) recurrence following catheter ablation (CA) remains controversial. This study investigated the prognostic value of the non-high-density lipoprotein-cholesterol/high-density lipoprotein-cholesterol ratio (NHHR) in predicting postablation AF recurrence.

Methods

In this cohort study, 1,728 patients with AF undergoing first-time CA at our center (2017–2020) were stratified by NHHR quartiles (Q1–Q4). The primary endpoint was AF recurrence and the secondary endpoint was incidence of Major Adverse Cardiovascular and Cerebrovascular Events (MACCEs) following CA.

Results

A U-shaped association was observed between the NHHR and AF recurrence (Pnonlinear = 0.021), with an inflection point at NHHR = 2.61, driven predominantly by an increased recurrence risk at lower NHHR values. Compared to the third quartile (Q3) (2.62–3.26), patients in the first NHHR quartile (Q1) had a 63.6% higher risk of recurrence (hazard ratio [HR] = 1.636, 95% confidence interval [CI]: 1.235–2.166). For NHHR < 2.61, the risk of recurrence risk decreased with an adjusted HR of 0.715 (95% CI, 0.524–0.977, P = 0.035) for every one-unit increment in the NHHR. The association for NHHR values above the inflection point was not statistically significant. Subgroup analyses confirmed consistency across age, sex, AF subtypes and duration, diabetes mellitus, CHA2DS2-VA scores, left atrial diameter, and non-PVI lesions (Pinteraction > 0.05). Sensitivity analysis further validated the temporal robustness of the association. NHHR demonstrated no association with MACCEs, underscoring its AF-specific prognostic value.

Conclusions

NHHR exhibited a U-shaped association with postablation AF recurrence, driven primarily by an increased risk at lower values. It may serve as a nonlinear lipid biomarker, with its role at the higher values requiring further investigation. Integration into clinical risk stratification is warranted, although therapeutic targeting requires additional mechanistic validation.

Trial registration: ChiCTR-OCH-14004674.