Association of novel lipid markers with cardiovascular and cerebrovascular disease risk: A cross-sectional NHANES 1999 to 2018 study

Dyslipidemia is central to cardiovascular and cerebrovascular diseases (CCVD). This study investigates associations of novel lipid markers – NHHR (non-HDL-C/HDL-C ratio), atherogenic index of plasma (AIP), and lipid accumulation product (LAP) – with CCVD risks using National Health and Nutrition Examination Survey data, comparing their predictive performance with traditional lipid and obesity indices. Data from 18,996 adults were analyzed. Multivariable logistic regression evaluated associations of NHHR/AIP/LAP with hypertension, heart failure, coronary heart disease, angina, and stroke. Restricted cubic splines (RCSs) tested nonlinearity, receiver operating characteristic curves assessed predictive ability, and subgroup analyses examined heterogeneity. Fully adjusted models revealed significant associations of NHHR and AIP with hypertension, heart failure, coronary heart disease, angina, and stroke, while LAP showed no link to stroke. RCS indicated nonlinear NHHR-hypertension and NHHR-coronary heart disease relationships ( P for nonlinear < .05). AIP exhibited nonlinear associations with hypertension and stroke, while LAP demonstrated threshold effects for hypertension, coronary heart disease, and angina. Subgroup analyses identified interactions: sex and diabetes modified NHHR-hypertension associations ( P < .05); AIP-hypertension links varied by sex, education, smoking, and body mass index (BMI); LAP-hypertension associations differed by sex and BMI ( P < .05). NHHR, AIP, and LAP independently predict CCVD risks, with AIP showing optimal stability, surpassing traditional markers. Prospective studies are needed to confirm causality.