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The predictive role of the hs-CRP/HDL-C ratio for long-term mortality in the general population: evidence from a
Yifeng Wang1, Li Wang2, Zongquan Zhao2
1Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, 210000, China.
Insights
The high-sensitivity C-reactive protein (hs-CRP) to high-density lipoprotein cholesterol (HDL-C) ratio predicts long-term mortality in the general population. Higher ratios are linked to increased all-cause and cardiovascular death risk.
Area of Science:
- Cardiovascular Health
- Inflammation Biomarkers
- Public Health Research
Background:
- The hs-CRP/HDL-C ratio, a marker of inflammation and lipid metabolism, is linked to cardiovascular disease (CVD) occurrence.
- Its predictive value for long-term mortality in the general population is not well-established.
Purpose of the Study:
- To investigate the association between the hs-CRP/HDL-C ratio and long-term all-cause and cardiovascular mortality.
- To determine if the hs-CRP/HDL-C ratio is an independent predictor of mortality in the general population.
Main Methods:
- Retrospective cohort study using NHANES data (2015-2018) from 9,492 US adults.
- Multivariate Cox regression, piecewise linear regression, and restricted cubic spline (RCS) models were employed.
- Subgroup analyses were conducted based on age, sex, smoking, and drinking status.
Main Results:
- Higher hs-CRP/HDL-C ratios were observed in participants who died from all causes or cardiovascular events.
- The hs-CRP/HDL-C ratio independently predicted both all-cause (HR=1.09) and cardiovascular mortality (HR=1.11).
- Mortality risk increased significantly when the hs-CRP/HDL-C ratio was below 1.21, with a stronger association in nonsmokers.
Conclusions:
- The hs-CRP/HDL-C ratio serves as a significant predictor of long-term mortality.
- This ratio is an independent risk factor for all-cause and cardiovascular mortality, even after adjusting for confounders.
Background:
The high-sensitivity C-reactive protein (hs-CRP) to high-density lipoprotein cholesterol (HDL-C) ratio, a composite marker of low-grade inflammation and lipid metabolism, is reportedly associated with the occurrence of new cardiovascular diseases (CVDs) in certain people. However, the predictive value of the hs-CRP/HDL-C ratio for long-term mortality in the general population remains unclear.
Methods:
This retrospective cohort study included data from 9,492 adults obtained from the National Health and Nutrition Examination Survey (NHANES) (2015-2018) in the United States. Multivariate Cox regression, two-piecewise linear regression, restricted cubic spline (RCS) models and subgroup analysis by age, sex, smoking status and drinking status were applied to evaluate the associations of the hs-CRP/HDL-C ratio with long-term all-cause and cardiovascular mortality.
Results:
The overall median age of the cohort was 47.0 years (interquartile range (IQR) 32.0-62.0), and 4,585 (48.30%) patients were male. During a median follow-up period of 37.0 months, 239 (2.52%) all-cause deaths occurred, 59 (0.62%) of which were attributed to cardiovascular events. Participants with all-cause and cardiovascular mortality presented a higher hs-CRP/HDL-C ratio than did those without events [0.56 (0.24-1.38) vs. 0.37 (0.14-0.94) and 0.60 (0.23-1.60) vs. 0.37 (0.14-0.95), P < 0.001 and P = 0.002]. According to multivariate Cox regression models, the hs-CRP/HDL-C ratio was found to be an independent risk factor for both long-term all-cause mortality [hazard ratio (HR) = 1.09, 95% confidence interval (CI): 1.05-1.13] and cardiovascular mortality (HR = 1.11, 95% CI: 1.05-1.19). A two-piecewise linear regression model indicated that the risk of all-cause mortality increased more prominently when the hs-CRP/HDL-C ratio was less than 1.21. In addition, a significant interaction effect with smoking status was discovered (P = 0.006), indicating that the association of the hs-CRP/HDL-C ratio with all-cause mortality was stronger in nonsmokers. The RCS curve revealed a positive linear association of the hs-CRP/HDL-C ratio with long-term mortality after adjustment for potential confounders.
Conclusions:
The hs-CRP/HDL-C ratio is a crucial predictor of long-term mortality in the general population, independent of potential confounding factors.
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