Association between the ratio of total cholesterol to high-density lipoprotein cholesterol and high cardiovascular risk: A cross-sectional study

Early identification of high-risk individuals for cardiovascular disease (CVD) and effective intervention and management can significantly reduce the incidence of CVD. The ratio of total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) reflects both the protective effect of high HDL-C levels and the detrimental impact of high low-density lipoprotein cholesterol levels and residual cholesterol. However, whether the TC/HDL-C ratio can effectively identify the high CVD risk population has not been fully verified. We conducted a cross-sectional analysis using community screening data from the ChinaHEART program in Luohe, China (2021-2022). Among 6860 adults aged 35 to 75 years, 6586 with valid lipid measurements were included in the final analyses. We evaluated the association between the TC/HDL-C ratio and World Health Organization-chart-defined high 10-year CVD risk (≥20%). According to restricted cubic spline analysis, the odds of high CVD risk were increased in individuals with a higher level of TC/HDL-C. Receiver operating characteristic analysis indicated that the TC/HDL-C ratio had good discriminatory power for high CVD risk, with an area under the curve of 0.847 in the fully adjusted model. Logistic regression analysis showed that for each 1-unit increase in the TC/HDL-C ratio, the odds ratio for high CVD risk was 1.97 (95% confidence interval: 1.83-2.13, P < .001). Compared with the lowest quartile of TC/HDL-C, the odds ratio for high CVD risk in the highest quartile was 2.95 (95% confidence interval: 2.42-3.60, P < .001). This study demonstrated that the TC/HDL-C ratio was independently linked to high CVD risk. These findings highlighted the importance of considering the TC/HDL-C ratio as a valuable tool in assessing CVD risk and guiding preventive strategies.