Key result
Non-HDL-c/HDL-c ratios below 2.685 are linked to ~21% greater stroke risk per unit change.
Why the study?
The association between the non-HDL-c/HDL-c ratio and stroke risk among middle-aged and older adults needed assessment.
Is the baseline non-HDL-c/HDL-c ratio associated with the risk of stroke in middle-aged and older adults?
Cohort (n=10,183)
Yes
Is the baseline non-HDL-c/HDL-c ratio associated with the risk of stroke in middle-aged and older adults?
Effect estimate: HR 1.214 (95% CI 1.039-1.418)
p-value: p=0.0145
The non-HDL-c/HDL-c ratio has a non-linear relationship with stroke risk in middle-aged and older Chinese adults, with a significant positive association only observed when the ratio is below 2.685.
Should not yet change stroke risk assessment; leaves open need for prospective validation of non-HDL-c/HDL-c thresholds.
Objective: This study aims to assess the association between the non-HDL-c/HDL-c ratio and stroke risk among middle-aged and older adults participating in the China Health and Retirement Longitudinal Study (CHARLS). Methods: This study conducted a prospective cohort analysis, enrolling a total of 10,183 participants who met the designated criteria from CHARLS between 2011 and 2012. We then used the Cox proportional-hazards regression model to explore the relationship between baseline non-HDL-c/HDL-c ratio and stroke risk. Using a Cox proportional hazards regression with cubic spline function, we were able to identify the non-linear relationship between the non-HDL-c/HDL-c ratio and stroke occurrence. A series of sensitivity analyses were also carried out. Results: The average age of the participants included in this study was 59.16 ± 9.35 years, and 4,735 individuals (46.68%) were male. Over a median follow-up period of 7.0 years, a total of 1,191 people (11.70%) experienced a stroke. Using a Cox proportional hazards regression model that was fully adjusted, we found no statistically significant correlation between the non-HDL-c/HDL-c ratio and the risk of stroke (HR=1.022; 95% CI 0.964, 1.083). Nevertheless, we did observe a non-linear relationship and saturation effect between the non-HDL-c/HDL-c ratio and stroke. Employing a two-piece Cox proportional hazards regression model and a recursive algorithm, we determined an inflection point of 2.685 for the non-HDL-c/HDL-c ratio. In instances where the non-HDL-c/HDL-c ratio fell below 2.685, for every 1-unit decrease in the non-HDL-c/HDL-c ratio, the likelihood of stroke decreased by 21.4% (HR=1.214, 95% CI: 1.039-1.418). In contrast, when the non-HDL-c/HDL-c ratio exceeded 2.685, there was no statistically significant change in the risk of stroke for each unit decrease in the non-HDL-c/HDL-c ratio (HR: 0.967, 95% CI: 0.897-1.042). The consistency of these findings across multiple sensitivity analyses suggests their robustness. Conclusion: This study unveils a non-linear relationship between the non-HDL-c/HDL-c ratio and stroke risk in middle-aged and older adults in China. Specifically, when the non-HDL-c/HDL-c ratio was below 2.685, a significant and clearly positive association with stroke risk was observed. Additionally, maintaining the non-HDL-c/HDL-c ratio below 2.685 could potentially lead to a substantial reduction in the risk of stroke.
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Wang et al. (2024) conducted a cohort in Stroke (n=10,183). Non-HDL-c/HDL-c ratio vs. Different levels of non-HDL-c/HDL-c ratio was evaluated on Incident stroke (HR 1.214, 95% CI 1.039-1.418, p=0.0145). The non-HDL-c/HDL-c ratio exhibited a non-linear relationship with stroke risk, where a ratio below 2.685 was significantly associated with stroke risk (HR 1.214 per unit change).
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