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Association of C-reactive protein/high-density lipoprotein cholesterol ratio with stroke in Chinese adults across

Wei Huang1,2, Jun Gu3, Xueli Sun1,2

  • 1Health Management Center, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China.

Lipids in Health and Disease
|February 10, 2026
PubMed

Insights

The C-reactive protein/high-density lipoprotein cholesterol ratio (CHR) is linked to higher stroke risk in Chinese adults, particularly in those with normal glucose regulation. This composite biomarker shows limited predictive ability but may aid in risk stratification.

Area of Science:

  • Cardiovascular epidemiology
  • Biomarker research
  • Public health

Background:

  • Stroke poses a significant public health challenge in China.
  • Novel biomarkers are needed for effective stroke risk stratification.
  • The C-reactive protein/high-density lipoprotein cholesterol ratio (CHR) integrates inflammation and lipid markers.

Purpose of the Study:

  • To investigate the association between CHR and incident stroke risk in Chinese adults.
  • To explore potential heterogeneity in this association based on glycemic status.
  • To assess the predictive performance of CHR for stroke.

Main Methods:

  • Longitudinal analysis of 10,484 Chinese adults (aged ≥45 years) from the CHARLS dataset (2011-2020).
  • Cox regression models were used to assess incident stroke risk.
  • Receiver operating characteristic (ROC) curves and Restricted Cubic Splines (RCS) evaluated predictive performance and non-linearity.

Main Results:

  • A cumulative stroke incidence of 9.19% was observed over 9 years.
  • Higher CHR was associated with increased stroke risk in prediabetes and diabetes, but not normal glucose regulation (NGR).
  • Non-linear, J-shaped associations were noted in NGR, with stronger risk in younger individuals (<60 years) and the highest CHR quartile.
  • CHR showed low discriminative ability for stroke prediction (AUC 0.572).

Conclusions:

  • Elevated CHR is associated with increased stroke risk in Chinese adults, with varying strength across glycemic statuses.
  • The association is stronger and non-linear (J-shaped) in individuals with normal glucose regulation compared to those with diabetes.
  • CHR's utility appears to be in risk stratification rather than standalone stroke prediction.
Abstract

Keywords:
Blood glucoseC-reactive proteinHigh-density lipoprotein cholesterolLongitudinal studyStroke

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