Pan Deng, Chen Peng-Fei, Ji Si-Yan, Chen Tie-Long, Zhang He
Department of Cardiology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310007, Zhejiang Province, China.
Department of Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China.
World J Cardiol. 2025 Jul 26;17(7):101434. doi: 10.4330/wjc.v17.i7.101434.
The non-high-density lipoprotein cholesterol (non-HDL-C)/HDL-C ratio (NHHR) is linked to cardiovascular event risk, but its prognostic value in diabetes mellitus (DM) patients remains unclear.
To explore the association of NHHR and cardiovascular mortality in patients with DM and generate predictive model.
This cohort study analyzed data from 8425 DM patients in National Health and Nutrition Examination Survey. NHHR was calculated as (total cholesterol - HDL-C)/HDL-C. Cardiovascular mortality was determined the National Death Index. Feature selection was performed using the Boruta algorithm and least absolute shrinkage and selection operator regression, followed by Cox proportional hazards models to evaluate NHHR's relationship with cardiovascular mortality. Stratified and sensitivity analyses assessed the findings' robustness. A nomogram was developed to predict cardiovascular mortality, with model performance evaluated using receiver operating characteristic curves and calibration plots.
Over an average follow-up of 94.2 months, 671 cardiovascular deaths (8.0%) occurred. Six key features including age, education, ethnicity, poverty-income ratio, history of heart failure, and NHHR, were selected. A non-linear association was found, with the highest NHHR quartile showing a 39% higher risk of cardiovascular death compared to the lowest quartile (Q4, hazard ratio: 1.39, 95% confidence interval: 1.11-1.73). Stratified analyses confirmed the increased risk across all subgroups. Sensitivity analyses supported the stability of the results. The nomogram for predicting cardiovascular mortality demonstrated high accuracy.
Elevated NHHR is associated with increased cardiovascular mortality risk in DM patients. NHHR could be a valuable prognostic marker, aiding in identifying high-risk patients and guiding targeted lipid management strategies.
非高密度脂蛋白胆固醇（non-HDL-C）/高密度脂蛋白胆固醇（HDL-C）比值（NHHR）与心血管事件风险相关，但其在糖尿病（DM）患者中的预后价值仍不明确。
探讨DM患者中NHHR与心血管死亡率的关联并建立预测模型。
这项队列研究分析了美国国家健康与营养检查调查中8425例DM患者的数据。NHHR计算为（总胆固醇-HDL-C）/HDL-C。通过国家死亡指数确定心血管死亡率。使用Boruta算法和最小绝对收缩和选择算子回归进行特征选择，然后采用Cox比例风险模型评估NHHR与心血管死亡率的关系。分层分析和敏感性分析评估了研究结果的稳健性。开发了一种列线图来预测心血管死亡率，使用受试者工作特征曲线和校准图评估模型性能。
在平均94.2个月的随访期内，发生了671例心血管死亡（8.0%）。选择了六个关键特征，包括年龄、教育程度、种族、贫困收入比、心力衰竭病史和NHHR。发现了一种非线性关联，NHHR最高四分位数组的心血管死亡风险比最低四分位数组高39%（第四四分位数，风险比：1.39，95%置信区间：1.ll-1.73）。分层分析证实所有亚组的风险均增加。敏感性分析支持结果的稳定性。预测心血管死亡率的列线图显示出高准确性。
NHHR升高与DM患者心血管死亡风险增加相关。NHHR可能是一个有价值的预后标志物，有助于识别高危患者并指导针对性的血脂管理策略。
