Association Between the Non-High-Density Lipoprotein Cholesterol to High-Density Lipoprotein Cholesterol Ratio and Carotid Plaque: A Retrospective Cohort Study

Why It Matters

NHHR offers a simple, inexpensive metric that enhances cardiovascular risk stratification beyond traditional lipid values, enabling earlier preventive action for carotid atherosclerosis.

Key Takeaways

• Highest NHHR quartile shows HR = 1.64 for carotid plaque
• Risk rises sharply until NHHR ≈ 4.07, then plateaus
• Younger adults, women, and normotensive participants have stronger associations
• Adding NHHR modestly raises AUC from 0.738 to 0.741
• NHHR derived from routine lipid panel, cost‑effective screening tool

Pulse Analysis

Carotid plaque is a silent precursor to stroke and coronary disease, yet routine screening remains limited to imaging studies that are costly and operator‑dependent. Traditional lipid markers such as LDL‑C or HDL‑C alone capture only part of the atherogenic profile, prompting researchers to explore composite ratios that reflect the balance between pro‑ and anti‑atherogenic lipoproteins. The non‑HDL‑C to HDL‑C ratio (NHHR) aggregates total atherogenic cholesterol while accounting for protective HDL, offering a more nuanced risk signal that can be calculated from any standard lipid panel.

In the Dalian Health Management Cohort, higher NHHR values were robustly linked to incident carotid plaque. After adjusting for age, sex, BMI, blood pressure, glucose, and medication use, participants in the highest quartile faced a 64% higher hazard (HR 1.64) than those in the lowest quartile. Restricted cubic spline modeling revealed a nonlinear trajectory, with risk climbing steeply until an NHHR of roughly 4.07 before flattening. Notably, the predictive gain was modest—area under the curve improved from 0.738 to 0.741—but the ratio proved especially informative for subpopulations traditionally considered lower risk, such as adults under 45, women, and normotensive individuals.

The clinical implications are straightforward: NHHR can be incorporated into existing cardiovascular risk calculators without additional testing expense, providing clinicians a quick flag for patients who may benefit from intensified lifestyle counseling or early pharmacologic intervention. While the study’s Chinese health‑examination cohort may limit generalizability, the findings encourage validation in diverse populations and suggest that NHHR could complement emerging imaging biomarkers. Future work should explore longitudinal changes in NHHR, its interaction with novel lipid‑lowering agents, and its role in guiding personalized prevention strategies.