Association of the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) with COPD prevalence and all-cause mortality: a population-based study based on NHANES 2007–2016
BackgroundThe non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) plays a potential role in metabolic and cardiovascular diseases. However, its association with chronic obstructive pulmonary disease (COPD) is not well-defined. Here, we aim to investigate the...
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Frontiers Media S.A.
2025-04-01
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2025.1533744/full |
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| author | Yu Liu Zheng Fan Hongmei Ren Cuixia Zheng |
| author_facet | Yu Liu Zheng Fan Hongmei Ren Cuixia Zheng |
| author_sort | Yu Liu |
| collection | DOAJ |
| description | BackgroundThe non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) plays a potential role in metabolic and cardiovascular diseases. However, its association with chronic obstructive pulmonary disease (COPD) is not well-defined. Here, we aim to investigate the potential association of NHHR with both the prevalence of COPD and all-cause mortality among individuals with COPD.MethodsThis population-based NHANES (2007–2016) study utilized weighted statistical analyses. Multivariable logistic regression assessed the NHHR-COPD prevalence association, with restricted cubic spline (RCS) testing for non-linearity. The association between NHHR and all-cause mortality in COPD was evaluated using Cox proportional hazards models and Kaplan-Meier, with RCS testing for non-linearity. Subgroup and sensitivity analyses confirmed the findings’ reliability.ResultsThis study included 6349 participants, of whom 1271 were diagnosed with COPD. Participants in the highest NHHR tertile demonstrated 62% higher odds of COPD prevalence compared to those in the lowest tertile (OR = 1.62, 95% CI:1.11–2.39, P = 0.017). Results from RCS analysis indicated a nonlinear relationship between NHHR and the prevalence of COPD (P for nonlinear = 0.007), with the curve demonstrating an inverted L-shape. Over an average follow-up period of 93 months, 320 participants with COPD died. In the weighted Kaplan-Meier survival analysis, participants with COPD in the lower NHHR tertile demonstrated greater cumulative probability of all-cause mortality compared to higher tertiles (P < 0.001). Weighted multivariable Cox regression models revealed an inverse association between NHHR levels and COPD all-cause mortality, with the highest NHHR tertile showing 11% lower likelihood of COPD all-cause mortality relative to the lowest tertile (HR = 0.89, 95% CI:0.80–0.99, P = 0.027). In addition, RCS analysis demonstrated a significant negative linear association between NHHR levels and all-cause mortality in COPD patients (P for nonlinear = 0.081). Subgroup and sensitivity analyses further confirmed the associations of NHHR on both morbidity and all-cause mortality.ConclusionHigher NHHR levels were associated with increased COPD prevalence yet inversely correlated with all-cause mortality in COPD patients. These paradoxical associations underscore the need for COPD-specific lipid management strategies that balance disease progression and mortality risks. |
| format | Article |
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| institution | OA Journals |
| issn | 2296-858X |
| language | English |
| publishDate | 2025-04-01 |
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| spelling | doaj-art-baacdb3d0b8443d49ed2185da09ea1832025-08-20T01:55:12ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2025-04-011210.3389/fmed.2025.15337441533744Association of the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) with COPD prevalence and all-cause mortality: a population-based study based on NHANES 2007–2016Yu LiuZheng FanHongmei RenCuixia ZhengBackgroundThe non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) plays a potential role in metabolic and cardiovascular diseases. However, its association with chronic obstructive pulmonary disease (COPD) is not well-defined. Here, we aim to investigate the potential association of NHHR with both the prevalence of COPD and all-cause mortality among individuals with COPD.MethodsThis population-based NHANES (2007–2016) study utilized weighted statistical analyses. Multivariable logistic regression assessed the NHHR-COPD prevalence association, with restricted cubic spline (RCS) testing for non-linearity. The association between NHHR and all-cause mortality in COPD was evaluated using Cox proportional hazards models and Kaplan-Meier, with RCS testing for non-linearity. Subgroup and sensitivity analyses confirmed the findings’ reliability.ResultsThis study included 6349 participants, of whom 1271 were diagnosed with COPD. Participants in the highest NHHR tertile demonstrated 62% higher odds of COPD prevalence compared to those in the lowest tertile (OR = 1.62, 95% CI:1.11–2.39, P = 0.017). Results from RCS analysis indicated a nonlinear relationship between NHHR and the prevalence of COPD (P for nonlinear = 0.007), with the curve demonstrating an inverted L-shape. Over an average follow-up period of 93 months, 320 participants with COPD died. In the weighted Kaplan-Meier survival analysis, participants with COPD in the lower NHHR tertile demonstrated greater cumulative probability of all-cause mortality compared to higher tertiles (P < 0.001). Weighted multivariable Cox regression models revealed an inverse association between NHHR levels and COPD all-cause mortality, with the highest NHHR tertile showing 11% lower likelihood of COPD all-cause mortality relative to the lowest tertile (HR = 0.89, 95% CI:0.80–0.99, P = 0.027). In addition, RCS analysis demonstrated a significant negative linear association between NHHR levels and all-cause mortality in COPD patients (P for nonlinear = 0.081). Subgroup and sensitivity analyses further confirmed the associations of NHHR on both morbidity and all-cause mortality.ConclusionHigher NHHR levels were associated with increased COPD prevalence yet inversely correlated with all-cause mortality in COPD patients. These paradoxical associations underscore the need for COPD-specific lipid management strategies that balance disease progression and mortality risks.https://www.frontiersin.org/articles/10.3389/fmed.2025.1533744/fullCOPD prevalenceall-cause mortalityNHHRNHANESlipid |
| spellingShingle | Yu Liu Zheng Fan Hongmei Ren Cuixia Zheng Association of the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) with COPD prevalence and all-cause mortality: a population-based study based on NHANES 2007–2016 Frontiers in Medicine COPD prevalence all-cause mortality NHHR NHANES lipid |
| title | Association of the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) with COPD prevalence and all-cause mortality: a population-based study based on NHANES 2007–2016 |
| title_full | Association of the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) with COPD prevalence and all-cause mortality: a population-based study based on NHANES 2007–2016 |
| title_fullStr | Association of the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) with COPD prevalence and all-cause mortality: a population-based study based on NHANES 2007–2016 |
| title_full_unstemmed | Association of the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) with COPD prevalence and all-cause mortality: a population-based study based on NHANES 2007–2016 |
| title_short | Association of the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) with COPD prevalence and all-cause mortality: a population-based study based on NHANES 2007–2016 |
| title_sort | association of the non high density lipoprotein cholesterol to high density lipoprotein cholesterol ratio nhhr with copd prevalence and all cause mortality a population based study based on nhanes 2007 2016 |
| topic | COPD prevalence all-cause mortality NHHR NHANES lipid |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2025.1533744/full |
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