Association of outcome with non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio in hospitalized patients with congestive heart failure: a retrospective analysis

Q: What are the key findings of this study?

In critically ill patients with congestive heart failure, the non-HDL to HDL cholesterol ratio exhibited a U-shaped association with mortality, where the second quartile (1.80-2.35) reduced 1-year mortality risk by 41% compared to the lowest quartile (HR 0.59).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Congestive heart failure (CHF) (n=2156). Intervention: Non-HDL cholesterol to HDL cholesterol ratio (NHHR) vs. Lowest NHHR quartile (Q1, <1.80). Primary outcome: 1-year all-cause mortality (Q2 vs Q1) (HR 0.59, 95% CI 0.44-0.80, p=0.001).

Q: What does this research mean for the field?

In critically ill patients with congestive heart failure, the non-HDL to HDL cholesterol ratio exhibits a U-shaped association with mortality, where moderate levels significantly reduce 1-year mortality risk compared to the lowest levels. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Lina Yu; Lianhong Xie

doi:10.1186/s13019-025-03551-2

July 25, 2025Journal of Cardiothoracic SurgeryOpen Access

Association of outcome with non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio in hospitalized patients with congestive heart failure: a retrospective analysis

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Key result

Second-quartile non-HDL/HDL ratios are linked to ~41% lower 1-year mortality in critically ill CHF.

HR 0.59
95% CI 0.44-0.80
P=0.001
n=2,156

Figures

Why the study?

The study was conducted to investigate the association between the Non-HDL cholesterol to HDL cholesterol ratio and all-cause mortality in patients with congestive heart failure, and to determine whether it influences prognosis.

Is the non-HDL cholesterol to HDL cholesterol ratio (NHHR) associated with all-cause mortality in hospitalized patients with congestive heart failure?

Key Points

To assess the relationship between the non-HDL to HDL cholesterol ratio (NHHR) and all-cause mortality in hospitalized patients with congestive heart failure.
Conducted a retrospective analysis of N=2,156 hospitalized patients with congestive heart failure stratified into quartiles based on baseline NHHR.
Evaluated mortality outcomes using Kaplan-Meier survival curves, multivariate Cox proportional hazards regression, and restricted cubic spline analyses across hospital, 28-day, 90-day, and 1-year intervals.
Among the 2,156 patients, all-cause mortality was 12.7% (274 deaths) during hospitalization, 15.6% (337 deaths) at 28 days, 22.3% (480 deaths) at 90 days, and 30.8% (665 deaths) at 1 year.
Restricted cubic spline models demonstrated a non-linear, U-shaped relationship between NHHR and mortality risk, showing an initial rapid decline followed by a steady increase.
Patients in the lowest quartile (Q1) had significantly higher 28-day, 90-day, and 1-year mortality rates (all P < 0.01 by log-rank test), with multivariate Cox regression confirming an independent association between NHHR and mortality.

Study Design

Type

Cohort (n=2,156)

Multicenter

No

Structured PICO

Is the non-HDL cholesterol to HDL cholesterol ratio (NHHR) associated with all-cause mortality in hospitalized patients with congestive heart failure?

P

Population

2156 hospitalized patients with congestive heart failure (CHF)

I

Intervention

Non-HDL cholesterol to HDL cholesterol ratio (NHHR) (observational exposure)

C

Comparator

Different quartiles of NHHR

O

Outcome

All-cause mortality (during hospitalization, 28 days, 90 days, and 1 year)hard clinical

Main Result

Effect estimate: HR 0.59 (95% CI 0.44-0.80)

p-value: p=0.001

A U-shaped relationship exists between the non-HDL to HDL cholesterol ratio and all-cause mortality in hospitalized heart failure patients, suggesting both very low and high ratios are associated with worse prognosis.

Limitations

Single-center design based on the MIMIC-IV database may limit generalizability.
Retrospective nature carries risks of coding variability, incomplete documentation, and potential misclassification bias.
Did not account for the potential impact of dynamic NHHR fluctuations on patient outcomes.
Discriminative efficacy of NHHR for all-cause mortality was at a moderate-to-low level.
Inherent selection bias and information bias characteristic of retrospective studies.

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Implication

NHHR may aid mortality risk stratification in hospitalized HF; observational data leaves causal role and practice change open.

Abstract

OBJECTIVE: To investigate the association between the Non-HDL cholesterol to HDL cholesterol ratio (NHHR) and all-cause mortality in patients with congestive heart failure (CHF) and to determine whether NHHR levels influence the prognosis of CHF patients. METHODS: The study participants were stratified based on the quartiles of NHHR. Kaplan-Meier (KM) curves, multivariate Cox regression analysis, and restricted cubic spline (RCS) analysis were employed to determine whether the prognosis of CHF patients varied according to NHHR levels. RESULTS: Our study included 2156 patients, of whom 274 (12.7%) died during hospitalization, 337 (15.6%) within 28 days, 480 (22.3%) within 90 days, and 665 (30.8%) within one year. Restricted cubic spline (RCS) analysis revealed a distinct U-shaped association between NHHR levels and mortality in CHF patients, characterized by an initial rapid decline followed by a gradual increase in mortality risk. Notably, patients in the lowest NHHR quartile (Q1) demonstrated significantly elevated 28-day, 90-day, and 1-year mortality rates (all P < 0.01, as confirmed by the Log-rank test) compared to the lower three quartiles, as confirmed by log-rank tests. Following the adjustment for confounding variables, multivariate Cox regression analysis established a substantial correlation between NHHR and all-cause mortality in CHF patients. CONCLUSION: A virtually U-shaped link exists between NHHR and all-cause mortality in CHF patients, and further study is needed to corroborate this finding.

Discussion

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Cite This Study

Yu et al. (2025) conducted a cohort in Congestive heart failure (CHF) (n=2,156). Non-HDL cholesterol to HDL cholesterol ratio (NHHR) vs. Lowest NHHR quartile (Q1, <1.80) was evaluated on 1-year all-cause mortality (Q2 vs Q1) (HR 0.59, 95% CI 0.44-0.80, p=0.001). In critically ill patients with congestive heart failure, the non-HDL to HDL cholesterol ratio exhibited a U-shaped association with mortality, where the second quartile (1.80-2.35) reduced 1-year mortality risk by 41% compared to the lowest quartile (HR 0.59).

synapsesocial.com/papers/6a11f1c5f7bd4f5c7da5988b https://doi.org/10.1186/s13019-025-03551-2

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Association of outcome with non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio in hospitalized patients with congestive heart failure: a retrospective analysis

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Association of outcome with non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio in hospitalized patients with congestive heart failure: a retrospective analysis

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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