Predictive Value of Non-High-Density to High-Density Lipoprotein Ratio for Coronary Heart Disease and Mortality in Adults

Abstract

Background Coronary heart disease (CHD) significantly impacts public health worldwide. Non-high-density lipoprotein cholesterol (non-HDL-C) and high-density lipoprotein cholesterol (HDL-C) are vital in lipid metabolism. The ratio of non-HDL-C to HDL-C (NHHR) may predict CHD and mortality. Objective This study investigates the relationship between NHHR and CHD incidence and its predictive value for all-cause and cardiovascular mortality in adults. Methods Data were collected from NHANES (2005–2016), including participants aged 18–80 years. NHHR was calculated by dividing non-HDL-C by HDL-C. Multivariable logistic regression and Cox proportional hazards models assessed associations between NHHR, CHD prevalence, and mortality outcomes. Results Higher NHHR levels were significantly associated with lower CHD prevalence in all adjusted models. The highest NHHR quartile showed the strongest inverse association with CHD prevalence (Model 3: Q4, OR = 0.93, 95% CI: 0.31–0.50, P < 0.0001). Higher NHHR quartiles also correlated with reduced all-cause and cardiovascular mortality risks. The restricted cubic spline analysis indicated a non-linear relationship, with the most significant protective effect at an NHHR value of approximately 3. Conclusions NHHR is a robust predictor of CHD and mortality. Incorporating NHHR into cardiovascular risk assessments could better identify high-risk individuals, guiding personalized prevention and treatment strategies.