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Changes in non-high-density lipoprotein to high-density lipoprotein ratio (NHHR) and cardiovascular disease: insights
Bingxue Wang1,2, LiYing Li3, Ying Tang1,2
1Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, China.
Insights
Elevated non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR), including changes over time, significantly increases cardiovascular disease (CVD) risk in adults over 45. Monitoring NHHR aids in CVD risk stratification.
Area of Science:
- Cardiology
- Public Health
- Biostatistics
Background:
- The link between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and cardiovascular disease (CVD) risk is known.
- However, the impact of NHHR *changes* on CVD events requires further investigation.
- This study explores NHHR change patterns and their association with incident CVD in a large population.
Purpose of the Study:
- To investigate the correlation between NHHR change patterns and the incidence of CVD.
- To assess the predictive value of baseline, cumulative, and dynamic NHHR for CVD events.
Main Methods:
- Utilized data from the China Health and Retirement Longitudinal Study (CHARLS).
- Calculated NHHR = (TC-HDL-c)/HDL-c.
- Employed latent profile analysis for NHHR change patterns, Cox regression, and restricted cubic spline analyses for association with incident CVD.
Main Results:
- Included 4,629 participants (57.47 years avg. age, 53.7% female); 879 CVD cases observed.
- Highest tertiles of baseline and cumulative NHHR showed significantly increased CVD risk (HRs ~1.43-1.45).
- Latent profiles indicated increased CVD risk in Class 2 (27%) and Class 3 (41%) vs. Class 1, with a linear relationship.
Conclusions:
- Baseline NHHR, cumulative NHHR, and NHHR changes are significant predictors of increased CVD risk in individuals aged 45+.
- These NHHR metrics demonstrate utility for CVD risk stratification.
- Dynamic monitoring of NHHR may enhance cardiovascular risk assessment.
Background:
The established association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and cardiovascular disease (CVD) risk has been well-documented. Nevertheless, the relationship between changes in NHHR and CVD events remains to be elucidated. The present study aims to clarify the correlation between NHHR change patterns and the incidence of CVD across a broad population.
Methods:
The current study recruited participants from the China Health and Retirement Longitudinal Study (CHARLS). The NHHR index was calculated using the formula: NHHR = (TC-HDL-c)/HDL-c. Temporal changes in NHHR were assessed with latent profile analysis, and cumulative NHHR was also evaluated. Multivariable Cox proportional hazards regression models and multivariate-adjusted restricted cubic spline (RCS) analyses were employed to examine the association between the NHHR index and incident CVD.
Results:
A total of 4,629 individuals were recruited for the study. The average age of the participants was 57.47 years, with 53.7% being female. Over the follow-up period, 879 cases of CVD were documented. Compared to participants in the lowest tertile, those in the highest tertile for both baseline NHHR and cumulative NHHR exhibited a significantly increased risk of CVD, with adjusted hazard ratios (HRs) of 1.43 (95% confidence interval [CI]: 1.21-1.70) and 1.45 (95% CI: 1.23-1.72), respectively. Participants classified in Class 2 demonstrated a 27% higher risk of CVD, while those in Class 3 showed a 41% greater risk compared to the Class 1 group. Further analysis revealed that this relationship was linear. Stratified analyses corroborated the primary findings.
Conclusion:
Baseline NHHR, cumulative NHHR, and changes in NHHR are significantly associated with an increased risk of CVD among individuals aged 45 years and older, thereby confirming their potential as valuable tools for risk stratification in CVD.
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