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Association between LDL-C/HDL-C ratio and first stroke in hypertensive patients: a prospective cohort study

Chao Yu1,2, Meihui Wu3,4, Lingjuan Zhu1,2

  • 1Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.

Frontiers in Endocrinology
|September 29, 2025
PubMed

Insights

A high ratio of low-density lipoprotein cholesterol (LDL-C) to high-density lipoprotein cholesterol (HDL-C) significantly increases first stroke risk in hypertensive patients. This association is particularly strong among current drinkers.

Area of Science:

  • Cardiovascular Medicine
  • Epidemiology
  • Hypertension Research

Background:

  • Limited evidence exists on the link between the LDL-C/HDL-C ratio and first stroke in hypertensive individuals.
  • Hypertension is a major risk factor for stroke, necessitating further investigation into contributing lipid profiles.

Purpose of the Study:

  • To investigate the association between the LDL-C/HDL-C ratio and the risk of first stroke.
  • To assess this relationship specifically within a cohort of Chinese hypertensive patients.

Main Methods:

  • Prospective cohort study of 12,893 Chinese hypertensive patients.
  • Utilized Cox proportional hazards regression, restricted cubic spline, and subgroup analyses.
  • Hazard ratios (HR) and 95% confidence intervals (CI) were calculated to quantify risk.

Main Results:

  • Each 1-unit increase in LDL-C/HDL-C ratio was associated with a 43% increased risk of first stroke (HR=1.43).
  • A significant trend of increasing stroke risk was observed across higher quartiles of the LDL-C/HDL-C ratio (P for trend < 0.001).
  • The association was linear and stronger in current drinkers (P for interaction=0.024).

Conclusions:

  • Elevated LDL-C/HDL-C ratio is a significant risk factor for first stroke in hypertensive patients.
  • Current drinkers with a high LDL-C/HDL-C ratio face a particularly elevated risk.
Abstract

Keywords:
LDL-C/HDL-C ratioalcohol drinkingcohort studyfirst strokehypertension

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