Non-high-density Lipoprotein Cholesterol to High-density Lipoprotein Cholesterol Ratio (NHHR) and Hypertension in American Adults: a NHANES Cross-sectional Study

Overview

Journal Front Physiol

Date 2024 Aug 28

PMID 39193442

Authors

Jiabei Wu

Jinli Guo

Affiliations

Soon will be listed here.

Abstract

Objectives: The relationship between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and hypertension remains uncertain, warranting further investigation. This study aims to elucidate the association between NHHR and hypertension.

Methods: A comprehensive cross-sectional stratified survey involving 30,602 participants aged 20 years and older was conducted using the National Health and Nutrition Examination Survey (NHANES) dataset from 2001 to 2018. NHHR was calculated as [total cholesterol (TC) - high-density lipoprotein cholesterol (HDL-C)]/HDL-C. The relationship between NHHR and hypertension was examined using weighted multiple linear regression, smooth curve fitting, hierarchical analysis, and interaction testing.

Results: The mean age of participants was 49.82 ± 17.64 years, with 15,266 women included. The average NHHR was 2.94 ± 0.56. A positive correlation between NHHR and hypertension was observed. Stratification of NHHR into quartiles, in the fully adjusted Model 3, revealed that individuals in the highest NHHR quartile had a 60% increased risk of hypertension for each unit increase in NHHR compared to those in the lowest quartile. Interaction tests indicated that the relationship between NHHR and hypertension remained consistent across subgroups, except for gender, age, education, and smoking status, which influenced this association.

Conclusion: Analysis of NHANES data from 2001 to 2018 demonstrated a consistent positive association between NHHR and hypertension. NHHR may provide potential assistance in hypertension prevention and diagnosis.

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References

Carr S, Hooper A, Sullivan D, Burnett J . Non-HDL-cholesterol and apolipoprotein B compared with LDL-cholesterol in atherosclerotic cardiovascular disease risk assessment. Pathology. 2019; 51(2):148-154. DOI: 10.1016/j.pathol.2018.11.006. View

Roth G, Nguyen G, Forouzanfar M, Mokdad A, Naghavi M, Murray C . Estimates of global and regional premature cardiovascular mortality in 2025. Circulation. 2015; 132(13):1270-82. DOI: 10.1161/CIRCULATIONAHA.115.016021. View

Sheng G, Kuang M, Yang R, Zhong Y, Zhang S, Zou Y . Evaluation of the value of conventional and unconventional lipid parameters for predicting the risk of diabetes in a non-diabetic population. J Transl Med. 2022; 20(1):266. PMC: 9188037. DOI: 10.1186/s12967-022-03470-z. View

Wang A, Li Y, Zhou L, Liu K, Li S, Zong C . Non-HDL-C/HDL-C ratio is associated with carotid plaque stability in general population: A cross-sectional study. Front Neurol. 2022; 13:875134. PMC: 9520290. DOI: 10.3389/fneur.2022.875134. View

Qing G, Deng W, Zhou Y, Zheng L, Wang Y, Wei B . The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and suicidal ideation in adults: a population-based study in the United States. Lipids Health Dis. 2024; 23(1):17. PMC: 10788025. DOI: 10.1186/s12944-024-02012-4. View

Sun Y, Mu J, Wang D, Ouyang N, Xing L, Guo X . A village doctor-led multifaceted intervention for blood pressure control in rural China: an open, cluster randomised trial. Lancet. 2022; 399(10339):1964-1975. DOI: 10.1016/S0140-6736(22)00325-7. View

Chatterjee S, Chattopadhyay S, Hope-Ross M, Lip P, Chattopadhya S . Hypertension and the eye: changing perspectives. J Hum Hypertens. 2002; 16(10):667-75. DOI: 10.1038/sj.jhh.1001472. View

Forouzanfar M, Liu P, Roth G, Ng M, Biryukov S, Marczak L . Global Burden of Hypertension and Systolic Blood Pressure of at Least 110 to 115 mm Hg, 1990-2015. JAMA. 2017; 317(2):165-182. DOI: 10.1001/jama.2016.19043. View

Ding C, Chen Y, Shi Y, Li M, Hu L, Zhou W . Association between nontraditional lipid profiles and peripheral arterial disease in Chinese adults with hypertension. Lipids Health Dis. 2020; 19(1):231. PMC: 7640397. DOI: 10.1186/s12944-020-01407-3. View

10.

Au A, Cheng K, Wei L . Metabolomics, Lipidomics and Pharmacometabolomics of Human Hypertension. Adv Exp Med Biol. 2016; 956:599-613. DOI: 10.1007/5584_2016_79. View

11.

Antza C, Cifkova R, Kotsis V . Hypertensive complications of pregnancy: A clinical overview. Metabolism. 2017; 86:102-111. DOI: 10.1016/j.metabol.2017.11.011. View

12.

Wang Z, Wu M, Du R, Tang F, Xu M, Gu T . The relationship between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and hyperuricaemia. Lipids Health Dis. 2024; 23(1):187. PMC: 11191326. DOI: 10.1186/s12944-024-02171-4. View

13.

Kaneva A, Bojko E . Sex differences in the association between obesity and hypertension. Arch Physiol Biochem. 2021; 129(3):682-689. DOI: 10.1080/13813455.2020.1861027. View

14.

Vrijens B, Antoniou S, Burnier M, De La Sierra A, Volpe M . Current Situation of Medication Adherence in Hypertension. Front Pharmacol. 2017; 8:100. PMC: 5331678. DOI: 10.3389/fphar.2017.00100. View

15.

Pandit A, Tang J, Bailey S, Davis T, Bocchini M, Persell S . Education, literacy, and health: Mediating effects on hypertension knowledge and control. Patient Educ Couns. 2009; 75(3):381-5. DOI: 10.1016/j.pec.2009.04.006. View

16.

Shen Q, Xu Q, Li G, Ren L, Zhang Z, Zhang Y . Joint effect of 25-hydroxyvitamin D and secondhand smoke exposure on hypertension in non-smoking women of childbearing age: NHANES 2007-2014. Environ Health. 2021; 20(1):117. PMC: 8591921. DOI: 10.1186/s12940-021-00803-1. View

17.

Virdis A, Giannarelli C, Neves M, Taddei S, Ghiadoni L . Cigarette smoking and hypertension. Curr Pharm Des. 2010; 16(23):2518-25. DOI: 10.2174/138161210792062920. View

18.

Sun L, Clarke R, Bennett D, Guo Y, Walters R, Hill M . Causal associations of blood lipids with risk of ischemic stroke and intracerebral hemorrhage in Chinese adults. Nat Med. 2019; 25(4):569-574. PMC: 6795549. DOI: 10.1038/s41591-019-0366-x. View

19.

Xie H, Zhuang Q, Mu J, Sun J, Wei P, Zhao X . The relationship between lipid risk score and new-onset hypertension in a prospective cohort study. Front Endocrinol (Lausanne). 2022; 13:916951. PMC: 9555054. DOI: 10.3389/fendo.2022.916951. View

20.

Di Chiara T, Scaglione A, Corrao S, Argano C, Pinto A, Scaglione R . Education and hypertension: impact on global cardiovascular risk. Acta Cardiol. 2017; 72(5):507-513. DOI: 10.1080/00015385.2017.1297626. View