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Background <p>Previous research has explored the association between the ratio of high-density lipoprotein cholesterol to C-reactive protein (HDL-C/CRP) and the mortality risk in individuals with heart failure. This study aims to investigate the correlation between HDL-C/CRP ratio and all-cause mortality through the analysis of extensive data derived from the general public. </p> Methods <p>This study analyzed NHANES data and surveyed 28,544 adults from America. Survival outcomes were evaluated using Kaplan–Meier curves, while a survey-weighted multivariable Cox proportional hazards model was employed. Restricted cubic splines (RCS) and hierarchical analysis were used to investigate associations and interactions, respectively. Additionally, the ability of lnHDL-C/CRP to predict all-cause death was assessed using receiver operating characteristic curves.</p> Results <p>During a mean follow-up period of 156.5&#xa0;months, 5965 (20.9%) died from any cause. Weighted RCS analysis revealed an L-shaped association between HDL-C/CRP ratio and all-cause mortality. Below a lnHDL-C/CRP of 6.65 (HDL-C/CRP ratio of 773), the likelihood of all-cause death decreased by 14% with every 1-point rise in lnHDL-C/CRP [HR (95% CI) 0.86 (0.81, 0.90)]. Including lnHDL-C/CRP in the baseline risk model significantly enhanced its predictive power for mortality. Consistent findings were observed in subgroups, with individuals under 60&#xa0;years or with a BMI over 30 showing a stronger correlation between HDL-C/CRP ratio and overall mortality risk.</p> Conclusions <p>The association between HDL-C/CRP ratio and overall mortality in the general US adult population is non-linear, particularly significant in adults under 60&#xa0;years old and obese individuals. HDL-C/CRP ratio could be regarded as a potential marker for assessing mortality risk<b>.</b></p>

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Non-linear correlation between the ratio of high-density lipoprotein cholesterol to C-reactive protein and all-cause mortality in adults: an extensive study based on nationwide data

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月1日

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  • Shujuan Qiu,
  • Jinhua Zhu,
  • Mengxue Yuan,
  • Zhentao Guo

摘要

Background

Previous research has explored the association between the ratio of high-density lipoprotein cholesterol to C-reactive protein (HDL-C/CRP) and the mortality risk in individuals with heart failure. This study aims to investigate the correlation between HDL-C/CRP ratio and all-cause mortality through the analysis of extensive data derived from the general public.

Methods

This study analyzed NHANES data and surveyed 28,544 adults from America. Survival outcomes were evaluated using Kaplan–Meier curves, while a survey-weighted multivariable Cox proportional hazards model was employed. Restricted cubic splines (RCS) and hierarchical analysis were used to investigate associations and interactions, respectively. Additionally, the ability of lnHDL-C/CRP to predict all-cause death was assessed using receiver operating characteristic curves.

Results

During a mean follow-up period of 156.5 months, 5965 (20.9%) died from any cause. Weighted RCS analysis revealed an L-shaped association between HDL-C/CRP ratio and all-cause mortality. Below a lnHDL-C/CRP of 6.65 (HDL-C/CRP ratio of 773), the likelihood of all-cause death decreased by 14% with every 1-point rise in lnHDL-C/CRP [HR (95% CI) 0.86 (0.81, 0.90)]. Including lnHDL-C/CRP in the baseline risk model significantly enhanced its predictive power for mortality. Consistent findings were observed in subgroups, with individuals under 60 years or with a BMI over 30 showing a stronger correlation between HDL-C/CRP ratio and overall mortality risk.

Conclusions

The association between HDL-C/CRP ratio and overall mortality in the general US adult population is non-linear, particularly significant in adults under 60 years old and obese individuals. HDL-C/CRP ratio could be regarded as a potential marker for assessing mortality risk.