Association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and cardiovascular mortality among US adults with diabetes: a prospective cohort study of NHANES 1999–2018

Abstract Background: The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) integrates information on atherogenic and anti-atherogenic lipoproteins. Its association with cardiovascular mortality in adults with diabetes remains unclear.

Methods

We conducted a prospective cohort analysis of ten National Health and Nutrition Examination Survey (NHANES) cycles (1999-2018) linked to mortality follow-up through December 31, 2019. Diabetes was defined by self-reported diagnosis, insulin use, oral glucose-lowering medication use, or hemoglobin A1c (HbA1c) ≥6.5%. NHHR was calculated as (total cholesterol - HDL-C)/HDL-C. Survey-weighted cause-specific Cox models and restricted cubic splines were used to examine the association between NHHR and cardiovascular mortality.