Yu Binyang, Li Min, Yu Zongliang, Zheng Tao, Feng Xue, Gao Anran, Zhang Haoling, Gao Rui
Graduate School, Beijing University of Chinese Medicine, Beijing, 100029, China.
Xiyuan Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, 100091, China.
BMC Med. 2024 Aug 7;22(1):317. doi: 10.1186/s12916-024-03536-3.
The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) serves as a novel composite lipid indicator for atherosclerosis. However, the association between NHHR and mortality in patients with diabetes or prediabetes remains unclear. Consequently, the objective of this study was to investigate the relationship between NHHR and both all-cause and cardiovascular mortality in US adults with diabetes or prediabetes.
This study included 12,578 adult participants with diabetes or prediabetes from the US National Health and Nutrition Examination Survey (1999-2018). Mortality outcomes were ascertained by linking to the National Death Index (NDI) record up to December 31, 2019. We employed a weighted multivariate Cox proportional hazards model and restricted cubic splines to assess the associations between NHHR and all-cause and cardiovascular mortality. A segmented Cox proportional hazards model was used for evaluating threshold effects. Furthermore, a competing risks analysis was performed to explore the relationship between NHHR and cardiovascular mortality.
During a median follow-up period of 8.08 years, 2403 participants encountered all-cause mortality, with 662 of them specifically succumbing to cardiovascular mortality. The restricted cubic splines revealed a U-shaped association between NHHR and all-cause mortality, while an L-shaped association was observed for cardiovascular mortality. The analysis of threshold effects revealed that the inflection points for NHHR and all-cause and cardiovascular mortality were 2.72 and 2.83, respectively. Specifically, when the baseline NHHR was below the inflection points, a negative correlation was observed between NHHR and both all-cause mortality (HR: 0.76, 95% CI: 0.68-0.85) and cardiovascular mortality (HR: 0.70, 95% CI: 0.57-0.85). Conversely, when the baseline NHHR exceeded the inflection points, a positive correlation was observed between NHHR and both all-cause mortality (HR: 1.11, 95% CI: 1.06-1.16) and cardiovascular mortality (HR: 1.08, 95% CI: 1.00-1.16).
Among US adults with diabetes or prediabetes, a U-shaped association was observed between NHHR and all-cause mortality, whereas an L-shaped association was identified with cardiovascular mortality. The inflection points for all-cause and cardiovascular mortality were 2.72 and 2.83, respectively.
非高密度脂蛋白胆固醇与高密度脂蛋白胆固醇比值（NHHR）是一种新型的动脉粥样硬化复合血脂指标。然而，NHHR与糖尿病或糖尿病前期患者死亡率之间的关联仍不明确。因此，本研究的目的是调查美国糖尿病或糖尿病前期成年人中NHHR与全因死亡率和心血管死亡率之间的关系。
本研究纳入了来自美国国家健康与营养检查调查（1999 - 2018年）的12578名患有糖尿病或糖尿病前期的成年参与者。通过与截至2019年12月31日的国家死亡指数（NDI）记录相链接来确定死亡结局。我们采用加权多变量Cox比例风险模型和受限立方样条来评估NHHR与全因死亡率和心血管死亡率之间的关联。采用分段Cox比例风险模型评估阈值效应。此外，进行了竞争风险分析以探讨NHHR与心血管死亡率之间的关系。
在中位随访期8.08年期间，2403名参与者发生了全因死亡，其中662人 specifically死于心血管疾病。受限立方样条显示NHHR与全因死亡率之间呈U形关联，而心血管死亡率呈L形关联。阈值效应分析显示，NHHR与全因死亡率和心血管死亡率的拐点分别为2.72和2.83。具体而言，当基线NHHR低于拐点时，NHHR与全因死亡率（HR：0.76，95%CI：0.68 - 0.85）和心血管死亡率（HR：0.70，95%CI：0.57 - 0.85）均呈负相关。相反，当基线NHHR超过拐点时，NHHR与全因死亡率（HR：1.11，95%CI：1.06 - 1.16）和心血管死亡率（HR：1.08，95%CI：1.00 - 1.16）均呈正相关。
在美国患有糖尿病或糖尿病前期的成年人中，观察到NHHR与全因死亡率之间呈U形关联，而与心血管死亡率呈L形关联。全因死亡率和心血管死亡率的拐点分别为2.72和2.83。
