High-sensitivity CRP to HDL-C ratio as a novel inflammatory-lipid biomarker for mortality risk prediction: a prospective population-based cohort study

Background The study aimed to investigate the association between hs-CRP/HDL-C and all-cause and cause-specific mortality in the general population. Methods and Results A total of 10,124 participants aged over 18 years who had measured serum hs-CRP and HDL-C levels were obtained from the National Health and Nutrition Examination Survey (2015–2018). The baseline levels of hs-CRP/HDL-C were then evaluated in relation to the risk of mortality, with the use of restricted cubic splines and Cox proportional hazards regression models. Stratified analyses were also conducted to assess the stability of the results.During a median follow-up of 37 months, there were 338 deaths, including 82 from cardiovascular causes and 256 from non-cardiovascular causes (include 74 cancer causes). After adjusting for traditional risk factors, hs-CRP/HDL-C was independently associated with all-cause mortality (HR 1.09, 95%CI 1.06-1.12), cardiovascular mortality （HR 1.12, 95% CI 1.07-1.18）, cancer mortality (HR 1.10, 95% CI 1.04-1.17), and non-cardiovascular mortality (HR 1.08, 95% CI 1.04-1.12). Additionally, A significant interaction was observed between smoking status and hs-CRP/HDL-C ratio for both all-cause mortality (p for interaction = 0.015) and cancer mortality (p for interaction =0.021). Conclusion This study demonstrates that an elevated hs-CRP/HDL-C ratio is independently associated with increased risks of all-cause, cardiovascular, cancer and non-cardiovascular mortality.