Elevated non-HDL-C/HDL-C ratio increases the 1-year risk of recurrent stroke in older patients with non-disabling ischemic cerebrovascular events: results from the Xi’an Stroke Registry Study of China

Abstract

Background Few studies have explored the prognostic role of nontraditional lipid-related indicators in non-disabling ischemic cerebrovascular events (NICE). In this study, we aimed to investigate the relationship between the ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (non-HDL-C/HDL-C) and the1-year risk of recurrent stroke in patients with NICE. Methods Total cholesterol (TC), HDL-C, and patient information were collected at admission. Recurrent stroke events were followed up 3, 6, and 12 months after onset. Non-HDL-C levels were calculated by subtracting HDL-C from TC. The non-HDL-C/HDL-C ratio was treated as a continuous variable and in quartiles (Q1–Q4). Stratified multivariate Cox regression was used to investigate the relationship between the non-HDL-C/HDL-C ratio and the 1-year risk of recurrent stroke in patients with NICE. Results Overall, 1,659 patients with NICE were enrolled. For each unit increase in the non-HDL-C/HDL-C ratio, the 1-year risk of recurrent stroke in patients aged ≥ 65 years (older patients) with NICE increased by 64% in the adjusted model (hazard ratio [HR]: 1.64, 95%confidence interval [CI]:1.18–2.27, P = 0.003), and the HRs were 3.21 and 4.24 times higher in the Q3 and Q4 groups than that in the Q1 group, which was considered to be the reference (adjusted model Q3: HR: 3.21, 95%CI: 1.05–9.83, P = 0.041; adjusted model Q4: HR: 4.24, 95%CI: 1.30–13.85, P = 0.017). However, there was no significant difference in patients younger than 65 years. Both curve fitting and Kaplan–Meier cumulative risk analysis showed that an elevated non-HDL-C/HDL-C ratio significantly increased the 1-year risk of recurrent stroke in older patients with NICE. The optimal range for the non-HDL-C/HDL-C ratio should be no higher than the Q2 group (2.256–2.939). Stratified Cox regression analysis showed that these results tended to be stable for different comorbidities (all P for interaction > 0.05). Conclusions Elevated non-HDL-C/HDL-C ratios significantly increased the 1-year risk of recurrent stroke in older patients with NICE. Therefore, clinicians need to pay more attention to this indicator when managing older patients with NICE.

The non-linear link between non-high-density lipoprotein to high-density lipoprotein ratio and the risk of stroke in middle-aged and older adults in Chinese: a prospective cohort study from the China health and retirement longitudinal study

“…In the study conducted in Xi’an, China, it was found that elevated non-HDL-C/HDL-C ratios significantly heightened the one-year risk of recurrent stroke in older patients with non-disabling ischemic cerebrovascular events (NICE). Consequently, clinicians should place greater emphasis on this indicator when treating elderly individuals with NICE ( 46 ). A separate investigation conducted in Chinese individuals with metabolic syndrome has specifically examined the association between the non-HDL-c/HDL-c ratio and carotid atherosclerosis, revealing a positive correlation.…”

The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and suicidal ideation in adults: a population-based study in the United States

“…In the ongoing research into the association between psychological well-being and lipid metabolism, NHHR serves as a recently created composite indicator that assesses atherogenic lipid profiles and provides extensive insight into lipid particles that are both anti-atherogenic and atherogenic [ 11 ]. To determine the NHHR, non-HDL-C levels are divided by comparable HDL-C levels [ 12 ]. Previous research has shown that the NHHR exhibits superior diagnostic efficacy in comparison with standard lipid parameters in predicting the risk of cerebrovascular diseases, liver disease, insulin resistance, and metabolic syndrome [ 13 – 15 ].…”