Association Between LDL/HDL Ratio and Hypertension in Chinese Middle-aged and Older Adults: a Cross-sectional and Longitudinal Analysis Based on CHARLS LDL/HDL Ration and Hypertension

Overview

Journal Front Endocrinol (Lausanne)

Specialty Endocrinology

Date 2025 Mar 3

PMID 40026689

Authors

Weicheng Lai

Xiao Chen

Lerui Wang

Liangxiu Wu

Xin Li

Boda Zhou

Affiliations

Soon will be listed here.

Abstract

Introduction: Hypertension is a global public health issue and major risk factor for cardiovascular disease (CVD). Low-density lipoprotein/high-density lipoprotein ratio (LDL/HDL Ratio, LHR) is an important indicator of lipid metabolism related to CVD. However, the relationship between LHR and the prevalence and incidence of hypertension has not been reported in large populations. This study aims to investigate the association between LHR and hypertension in middle-aged and elderly population.

Methods: This study utilized the China Health and Retirement Longitudinal Study (CHARLS) database from 2011 to 2020. Cross-sectional study was employed to analyze the association between LHR and the prevalence of hypertension; longitudinal analysis was used to examine the association between LHR and the incidence of hypertension. Eligible participants were adults aged 45 years and older with complete LHR and self-reported hypertension records. Multivariate logistic regression, smooth curve fitting, threshold effect analysis was performed.

Results: In the cross-sectional study, we included 13,150 participants. After adjusting for potential confounders, each one-unit increase in LHR was associated with a 22% increase in the prevalence of hypertension (OR = 1.22, 95% CI: 1.15-1.30, < 0.0001). The association between LHR and hypertension was consistent across different subgroups, with higher LHR being more strongly associated with increased hypertension prevalence in females and non-smokers. Our results revealed a linear relationship between LHR and hypertension prevalence. Longitudinal analysis showed that, among participants without hypertension in 2011, after 7 years of follow-up, the association between LHR and hypertension incidence remained robust after adjusting for a wide range of demographic, clinical, and biochemical variables ( < 0.05).

Conclusions: These results demonstrated significant positive association between LHR and the prevalence & incidence of hypertension, in a nationwide representative middle-aged and elderly population in China.

References

Tan M, Weng L, Yang Z, Zhu S, Wu S, Su J . The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio with type 2 diabetes mellitus: recent findings from NHANES 2007-2018. Lipids Health Dis. 2024; 23(1):151. PMC: 11106869. DOI: 10.1186/s12944-024-02143-8. View

Tziomalos K, Athyros V, Karagiannis A, Mikhailidis D . Dyslipidemia as a risk factor for ischemic stroke. Curr Top Med Chem. 2009; 9(14):1291-7. DOI: 10.2174/156802609789869628. View

Xu J, Chen J, Liu Y, Song Y, Jiang L, Yan S . [The impact of LDL-C/HDL-C ratio on severity of coronary artery disease and 2-year outcome in patients with premature coronary heart disease: results of a prospective, multicenter, observational cohort study]. Zhonghua Xin Xue Guan Bing Za Zhi. 2023; 51(7):702-708. DOI: 10.3760/cma.j.cn112148-20230128-00043. View

Otrante A, Bounafaa A, Berrougui H, Essamadi A, Nguyen M, Fulop T . Small Dense LDL Level and LDL/HDL Distribution in Acute Coronary Syndrome Patients. Biomedicines. 2023; 11(4). PMC: 10135780. DOI: 10.3390/biomedicines11041198. View

Dobiasova M, Frohlich J . The plasma parameter log (TG/HDL-C) as an atherogenic index: correlation with lipoprotein particle size and esterification rate in apoB-lipoprotein-depleted plasma (FER(HDL)). Clin Biochem. 2001; 34(7):583-8. DOI: 10.1016/s0009-9120(01)00263-6. View

Grover S, Levinton C, Paquet S . Identifying adults at low risk for significant hyperlipidemia: a validated clinical index. J Clin Epidemiol. 1999; 52(1):49-55. DOI: 10.1016/s0895-4356(98)00139-5. View

Sun T, Chen M, Shen H, PingYin , Fan L, Chen X . Predictive value of LDL/HDL ratio in coronary atherosclerotic heart disease. BMC Cardiovasc Disord. 2022; 22(1):273. PMC: 9206383. DOI: 10.1186/s12872-022-02706-6. View

Yu Y, Li M, Huang X, Zhou W, Wang T, Zhu L . A U-shaped association between the LDL-cholesterol to HDL-cholesterol ratio and all-cause mortality in elderly hypertensive patients: a prospective cohort study. Lipids Health Dis. 2020; 19(1):238. PMC: 7659118. DOI: 10.1186/s12944-020-01413-5. View

Voglhuber J, Ljubojevic-Holzer S, Abdellatif M, Sedej S . Targeting Cardiovascular Risk Factors Through Dietary Adaptations and Caloric Restriction Mimetics. Front Nutr. 2021; 8:758058. PMC: 8514725. DOI: 10.3389/fnut.2021.758058. View

10.

Tang H, Li M, Liu L, Zhou Y, Liu X . Changing inequity in health service utilization and financial burden among patients with hypertension in China: evidence from China Health and Retirement Longitudinal Study (CHARLS), 2011-2018. Int J Equity Health. 2023; 22(1):246. PMC: 10668495. DOI: 10.1186/s12939-023-02062-7. View

11.

Yi Q, Hu H, Zeng Q . Association of triglycerides to high density lipoprotein cholesterol ratio with hypertension in Chinese adults: a cross-sectional study. Clin Exp Hypertens. 2023; 45(1):2195996. DOI: 10.1080/10641963.2023.2195996. View

12.

Adepu C, Sandeep Kumar Reddy B . Association of Serum Bilirubin and Lipid Ratio (Total Cholesterol/(High-Density Lipoprotein + Bilirubin)) in Coronary Artery Disease: A Case-Control Study at a Tertiary Care Hospital. Cureus. 2023; 15(10):e46420. PMC: 10621757. DOI: 10.7759/cureus.46420. View

13.

Isles C, Paterson J . Identifying patients at risk for coronary heart disease: implications from trials of lipid-lowering drug therapy. QJM. 2000; 93(9):567-74. DOI: 10.1093/qjmed/93.9.567. View

14.

Zhu L, Lu Z, Zhu L, Ouyang X, Yang Y, He W . Lipoprotein ratios are better than conventional lipid parameters in predicting coronary heart disease in Chinese Han people. Kardiol Pol. 2015; 73(10):931-8. DOI: 10.5603/KP.a2015.0086. View

15.

Hurtubise J, McLellan K, Durr K, Onasanya O, Nwabuko D, Ndisang J . The Different Facets of Dyslipidemia and Hypertension in Atherosclerosis. Curr Atheroscler Rep. 2016; 18(12):82. DOI: 10.1007/s11883-016-0632-z. View

16.

Hong D, Cho S, Park S, Kim S, Park S . Hair mercury level in smokers and its influence on blood pressure and lipid metabolism. Environ Toxicol Pharmacol. 2013; 36(1):103-7. DOI: 10.1016/j.etap.2013.03.007. View

17.

Busonero F, Lenarduzzi S, Crobu F, Gentile R, Carta A, Cracco F . The Women4Health cohort: a unique cohort to study women-specific mechanisms of cardio-metabolic regulation. Eur Heart J Open. 2024; 4(2):oeae012. PMC: 10964981. DOI: 10.1093/ehjopen/oeae012. View

18.

Mlynarska E, Czarnik W, Fularski P, Hajdys J, Majchrowicz G, Stabrawa M . From Atherosclerotic Plaque to Myocardial Infarction-The Leading Cause of Coronary Artery Occlusion. Int J Mol Sci. 2024; 25(13). PMC: 11242737. DOI: 10.3390/ijms25137295. View

19.

Gu C, Pang B, Sun S, An C, Wu M, Wang N . Neutrophil extracellular traps contributing to atherosclerosis: From pathophysiology to clinical implications. Exp Biol Med (Maywood). 2023; 248(15):1302-1312. PMC: 10625340. DOI: 10.1177/15353702231184217. View

20.

Libby P, Ridker P, Hansson G . Progress and challenges in translating the biology of atherosclerosis. Nature. 2011; 473(7347):317-25. DOI: 10.1038/nature10146. View