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HDL-C/LDL-C Ratio and All-Cause Mortality in Populations at High CVD Risk: A Prospective Observational Cohort Study
Biting Lin1,2,3, Yunzhi Ling2,3, Gengyu Zhou2,3
1Fujian University of Traditional Chinese Medicine Fuzhou Fujian China.
Insights
The high-density lipoprotein cholesterol (HDL-C) to low-density lipoprotein cholesterol (LDL-C) ratio predicts cardiovascular disease (CVD) risk, but this association is not found in individuals with type 2 diabetes mellitus (T2DM). Maintaining an HDL-C/LDL-C ratio between 0.3-0.5 is beneficial for high-risk CVD populations without T2DM.
Area of Science:
- Cardiovascular Medicine
- Metabolic Disorders
- Epidemiology
Background:
- The prognostic value of the high-density lipoprotein cholesterol (HDL-C) to low-density lipoprotein cholesterol (LDL-C) ratio for cardiovascular disease (CVD) endpoints is established.
- However, its predictive validity in high-risk populations and for type 2 diabetes mellitus (T2DM)-related adverse events remains unclear.
Purpose of the Study:
- To investigate the association between the HDL-C/LDL-C ratio and all-cause mortality in a high-risk CVD population in China.
- To determine if this association differs between individuals with and without T2DM.
Main Methods:
- A cohort of 32,609 individuals aged 35-75 years at high risk for CVD was analyzed.
- Cox proportional hazard models and restricted cubic spline (RCS) analysis were employed to assess the correlation between the HDL-C/LDL-C ratio and mortality.
- Participants were categorized into low (<0.3), middle (0.3-0.5), and high (>0.5) HDL-C/LDL-C ratio groups.
Main Results:
- Elevated risks of all-cause mortality were observed in both low (HR=1.48) and high (HR=1.30) HDL-C/LDL-C ratio groups compared to the middle group.
- This association was significant for high-risk CVD individuals without T2DM (low ratio: HR=1.65; high ratio: HR=1.35).
- No significant association between HDL-C/LDL-C ratio and mortality was found in high-risk CVD individuals with T2DM.
Conclusions:
- The HDL-C/LDL-C ratio can predict prognosis in high-risk CVD individuals.
- A ratio between 0.3 and 0.5 appears most beneficial for this population.
- This ratio is clinically significant for individuals without T2DM, but further research is needed for T2DM cohorts.
Background:
The ratio of high-density lipoprotein cholesterol (HDL-C) to low-density lipoprotein cholesterol (LDL-C) predicts cardiovascular disease (CVD) endpoints, yet its prognostic validity in high-risk populations and for type 2 diabetes mellitus (T2DM)-related adverse events remains unestablished.
Methods:
This study included 32,609 people aged 35-75 years in Fujian Province, China, who were at high risk for CVD. The primary endpoint was all-cause mortality during follow-up. Cox proportional hazard models and restricted cubic spline (RCS) analysis were used to evaluate the correlation between the HDL-C/LDL-C ratio and the endpoints.
Result:
On the basis of the restricted RCS curve, the participants were classified as having a low (< 0.3), middle (0.3-0.5), or high (> 0.5) HDL-C/LDL-C ratio. Multivariate Cox regression analyses revealed that the risk of all-cause mortality (HR = 1.48, 95% CI 1.14-1.93, p < 0.01 for low; HR = 1.30, 95% CI 1.06-1.58, p < 0.05 for high) was increased in the low and high groups. Participants without T2DM who were at high risk for CVD had similar prognoses (HR = 1.65, 95% CI 1.19-2.28, p < 0.01 for low; HR = 1.35, 95% CI 1.05-1.74, p < 0.01 for high). However, this association was not found in participants with T2DM who were at high risk for CVD.
Conclusion:
HDL-C/LDL-C can be used to predict the prognosis of individuals at high risk for CVD, and maintaining HDL-C/LDL-C ratios between 0.3 and 0.5 may be the most helpful range for this population. Furthermore, maintaining this ratio range holds clinical significance for cohorts without T2DM, although further exploration is needed in this T2DM cohort.
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