Department of Neurosurgery, Shenzhen Yantian District People's Hospital, Southern University of Science and Technology Yantian Hospital, Shenzhen, 518081, Guangdong, China.
Department of Rehabilitation, Shenzhen Second People's Hospital, Shenzhen Dapeng New District Nan'ao People's Hospital, No. 6, Renmin Road, Dapeng New District, Shenzhen, 518000, Guangdong, China.
Eur J Med Res. 2024 Mar 16;29(1):175. doi: 10.1186/s40001-024-01769-9.
OBJECTIVE: The connection between total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio and stroke risk is controversial. This study aims to examine the connection between the TC/HDL-C ratio and stroke in middle-aged and older individuals who are part of the China Health and Retirement Longitudinal Study (CHARLS). METHODS: This study conducted a retrospective cohort analysis, enrolling a total of 10,184 participants who met the designated criteria from CHARLS between 2011 and 2012. We then used the Cox proportional-hazards regression model to analyze the relationship between the TC/HDL-C ratio and stroke risk. Using a Cox proportional hazards regression model with cubic spline functions and smooth curve fitting, we were able to identify the non-linear relationship between the TC/HDL-C ratio and stroke occurrence. The sensitivity and subgroup analyses were also performed to investigate the connection between TC/HDL-C ratio and stroke. RESULTS: This study revealed a statistically significant association between the TC/HDL-C ratio and stroke risk in subjects aged 45 years or older after adjusting for risk factors (HR: 1.05, 95%CI 1.00-1.10, P = 0.0410). Furthermore, a non-linear connection between the TC/HDL-C ratio and stroke risk was detected, with a TC/HDL-C ratio inflection point of 3.71. We identified a significant positive connection between the TC/HDL-C ratio and stroke risk, when the TC/HDL-C ratio was less than 3.71 (HR: 1.25, 95%CI 1.07-1.45, P = 0.0039). However, their connection was not significant when the TC/HDL-C ratio exceeded 3.71 (HR: 1.00, 95%CI 0.94-1.06, P = 0.9232). The sensitivity analysis and subgroup analyses revealed that our findings were well-robust. CONCLUSION: Our study demonstrated a positive, non-linear connection between the TC/HDL-C ratio and stroke risk in middle-aged and older individuals. There was a significant positive connection between the TC/HDL-C ratio and stroke risk, when the TC/HDL-C ratio was less than 3.71. The current research can be used as a guideline to support clinician consultation and optimize stroke prevention measures for middle-aged and older adults.
目的：总胆固醇与高密度脂蛋白胆固醇（TC/HDL-C）比值与卒中风险之间的关系存在争议。本研究旨在探讨中国健康与养老追踪调查（CHARLS）中纳入的中年及以上人群 TC/HDL-C 比值与卒中之间的关系。
方法：本研究采用回顾性队列分析，纳入了 2011 年至 2012 年 CHARLS 中符合条件的 10184 名参与者。我们使用 Cox 比例风险回归模型分析 TC/HDL-C 比值与卒中风险之间的关系。采用 Cox 比例风险回归模型、三次样条函数和平滑曲线拟合，确定 TC/HDL-C 比值与卒中发生之间的非线性关系。还进行了敏感性和亚组分析，以探讨 TC/HDL-C 比值与卒中之间的关系。
结果：在调整了危险因素后，本研究发现 TC/HDL-C 比值与 45 岁及以上人群卒中风险之间存在统计学显著关联（HR：1.05，95%CI 1.00-1.10，P=0.0410）。此外，还检测到 TC/HDL-C 比值与卒中风险之间存在非线性关系，TC/HDL-C 比值拐点为 3.71。当 TC/HDL-C 比值小于 3.71 时，TC/HDL-C 比值与卒中风险之间存在显著正相关（HR：1.25，95%CI 1.07-1.45，P=0.0039）。然而，当 TC/HDL-C 比值超过 3.71 时，两者之间的关联并不显著（HR：1.00，95%CI 0.94-1.06，P=0.9232）。敏感性分析和亚组分析表明，我们的研究结果具有良好的稳健性。
结论：本研究表明，在中年及以上人群中，TC/HDL-C 比值与卒中风险之间存在正相关、非线性关系。当 TC/HDL-C 比值小于 3.71 时，TC/HDL-C 比值与卒中风险之间存在显著正相关。目前的研究可以作为指导临床医生咨询和优化中年及以上人群卒中预防措施的依据。
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