Association of non-highdensity lipoprotein cholesterol to highdensity lipoprotein cholesterol ratio (NHHR) and subsequent hypertension and heart diseases: findings from the CHARLS cohort

Abstract Purpose NHHR, the ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol, is a novel lipid marker associated with the risk of heart diseases and various health conditions. However, there is limited evidence regarding the relationship between NHHR and the onset of hypertension and heart diseases. The aim of this study was to investigate the association between NHHR and the new-onset hypertension and heart diseases among the Chinese middle-aged and older general population. Methods This prospective cohort study utilized data from a nationally representative sample of Chinese residents aged 45 and older, sourced from the China Health and Retirement Longitudinal Study (CHARLS). The primary outcomes of the study were new-onset hypertension and heart diseases. To investigate the relationship between the NHHR and the risk of new-onset hypertension and heart diseases, multivariate logistic regression models and the restricted cubic spline (RCS) method were employed. Additionally, the mediating effects of hypertension on the association between NHHR and heart diseases were assessed using the bootstrap method. Results A total of 5349 participants were included in the final analysis and three groups of NHHR were identified, including low-stable, medium-stable, and high-stable NHHR. By 2020, 1,631 participants (30.5%) had been newly diagnosed with hypertension, while 1233 (23.1%) developed heart diseases. Compared to those with a low-stable NHHR, individuals in the other two groups showed a significantly increased risk of developing hypertension and heart diseases. The findings remained consistent across various sensitivity analyses. According to the RCS analysis, a partial U-shaped relationship existed between the NHHR and the risk of developing hypertension and heart diseases (P for nonlinear < 0.001). Furthermore, hypertension was found to partially mediate the association between NHHR and heart diseases. Conclusion The NHHR was closely associated with an increased risk of developing hypertension and heart diseases. In addition, the NHHR partially mediated the development of heart diseases by promoting hypertension progression. In the prevention and treatment of heart diseases, managing both lipid levels and blood pressure is crucial.