The association of nontraditional lipid parameters with all-cause and cardiovascular mortality: A national cohort study

Nontraditional lipid parameters are increasingly recognized for clinical evaluation, yet their comparative ability to predict mortality risk in the general population remains ambiguous. This study aims to systematically explore the associations between 7 nontraditional lipid parameters and all-cause as well as cardiovascular mortality. This study analyzed data from the National Health and Nutrition Examination Survey database spanning the period from 1999 to 2018, which included 19,710 participants. The participants in this study were classified into 2 distinct categories: survivors (n = 16,364) and non-survivors (n = 3346). The study investigated the relationships between nontraditional lipid parameters and both all-cause and cardiovascular mortality. Cox proportional hazards regression models were utilized to evaluate the associations, supplemented by restricted cubic splines, receiver operating characteristic curves, as well as subgroup, interaction, and sensitivity analyses. Elevated levels of the atherogenic index of plasma and remnant cholesterol were associated with all-cause and cardiovascular mortality in unadjusted analyses, with risk rising progressively as levels increased. These associations were most pronounced in individuals under 65 years but were attenuated after adjustment for potential risk factors. Receiver operating characteristic curve analysis indicated that both parameters exhibited modest predictive capabilities, though their clinical significance requires further investigation. This study suggests that both the atherogenic index of plasma and remnant cholesterol are associated with all-cause and cardiovascular mortality in individuals under 65 years, exhibiting a dose–response relationship. Integrating these readily accessible parameters into age-specific risk stratification may be considered for exploratory purposes, but further validation is required before any clinical application. Future prospective studies are warranted to establish causality and evaluate targeted interventions based on these findings.