A nonlinear curve relating non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) to anxiety in American adults: A cross-sectional study

The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is an emerging composite lipid measure. Current evidence regarding the association between NHHR and anxiety is limited. Understanding how changes in the NHHR may affect anxiety. The secondary objective of this study was to examine whether the association between NHHR and anxiety follows a nonlinear pattern. We conducted a cross-sectional study involving 15,242 participants with The National Health and Nutrition Examination Survey (NHANES). Anxiety was obtained from all participants. Logistic regression and smooth curve fitting were used to substantiate the research objective. The overall prevalence of anxiety disorders was 25.6%. The analysis revealed statistically significant differences in the prevalence of anxiety across the NHHR groups within the study population. Multivariate restricted cubic spline (RCS) regression demonstrated a J-shaped nonlinear relationship between NHHR and anxiety ( P for nonlinearity < .05). The 2 variables exhibited a significant positive correlation, with the curve exhibiting a pronounced inflection point at NHHR values > 2.332. Furthermore, this relationship remained consistent across multiple subgroups stratified by sex, race, education level, marital status, body mass index (BMI), alcohol consumption, and smoking status. Using data from the NHANES (2007–2012), we investigated the association between NHHR levels and anxiety among adults in the United States. Analyses revealed a robust nonlinear J-shaped association. When the NHHR levels exceeded a threshold of 2.332, this relationship was associated with an increased risk of anxiety, highlighting its clinical relevance.