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ORIGINAL RESEARCH article

Front. Endocrinol.
Sec. Cardiovascular Endocrinology
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1490229
This article is part of the Research Topic Screening Remnant Lipid Markers in Cardiometabolic Diseases View all 6 articles

Non-high density lipoprotein cholesterol / high density lipoprotein cholesterol (NHHR) is L-shaped associated with all-cause mortality and U-shaped with cardiovascular mortality in hypertensive patients

Provisionally accepted
Meiqian Chen Meiqian Chen 1,2Li Zhang Li Zhang 1Qian Liu Qian Liu 1Qingxin Gu Qingxin Gu 1Guanzhen Lu Guanzhen Lu 1,2*
  • 1 Huzhou Central Hospital, Huzhou, China
  • 2 Huzhou University, Huzhou, Zhejiang, China

The final, formatted version of the article will be published soon.

    Background Patients with hypertension may have better survival rates when their lipid metabolism is in balance. The relationship between the novel composite lipid metric, NHHR, and all-cause and cardiovascular mortality in hypertensive patients remains unknown and warrants further investigation.We analyzed data from 5,561 hypertensive participants in the National Health and Nutrition Examination Survey (NHANES) spanning from 1999 to 2018. To determine the optimal NHHR cutoff point, we employed a maximum selection statistics approach. Participants were subsequently divided into groups for multivariate weighted Cox regression analysis. The association between NHHR and mortality risk was examined using restricted cubic splines (RCS).To investigate possible variations among different populations, subgroup analysis and interaction tests were carried out. The predictive capability of NHHR for survival outcomes was evaluated using time-dependent receiver operating characteristic (ROC) curves.Over a median follow-up period of 93 months, patients with hypertension exhibited an all-cause mortality rate of 21.78% and a cardiovascular mortality rate of 5.91%. A markedly elevated risk of cardiovascular death was associated with NHHR levels below 1.88 (HR 1.67; 95% CI 1.22-2.30; P =0.002), as well as an increased risk of all-cause mortality (HR 1.29; 95% CI 1.09-1.53; P = 0.003). Restricted cubic spline (RCS) analysis revealed a U-shaped relationship with cardiovascular mortality (P = 0.0385) and an L-shaped correlation with all-cause mortality (P < 0.0001). Areas under the curve (AUC) for cardiovascular mortality were 0.95, 0.68, and 0.81, and for all-cause mortality were 0.77, 0.84, and 0.80 for the 3-year, 5-year, and 10-year survival periods.The findings indicate that lower NHHR is associated with an increased risk of both cardiovascular and all-cause mortality, highlighting the critical need for comprehensive lipid management in the clinical management of hypertension. These results suggest that NHHR could serve as a valuable tool for identifying high-risk individuals for mortality, and should be incorporated into routine risk stratification assessments for hypertensive patients. This could more effectively improve patient prognosis and guide personalized treatment strategies.

    Keywords: non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio, Cardiovascular mortality, All-cause mortality, Hypertension, Lipid

    Received: 02 Sep 2024; Accepted: 06 Jan 2025.

    Copyright: © 2025 Chen, Zhang, Liu, Gu and Lu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Guanzhen Lu, Huzhou Central Hospital, Huzhou, China

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