Abstract
BackgroundThe low-density lipoprotein cholesterol/high-density lipoprotein- cholesterol (LDL-C/HDL-C) ratio is an excellent predictor of cardiovascular disease (CVD). However, previous studies linking the LDL-C/HDL-C ratio to mortality have yielded inconsistent results and been limited by short follow-up periods. Therefore, the aim of the present study was to determine whether the LDL-C/HDL-C ratio could be an effective predictor of all-cause mortality in elderly hypertensive patients.MethodsA total of 6941 hypertensive patients aged 65 years or older who were not treated with lipid-lowering drugs were selected from the Chinese Hypertension Registry for analysis. The endpoint of the study was all-cause mortality. The relationship between the LDL-C/HDL-C ratio and all-cause mortality was determined using multivariate Cox proportional hazards regression, smoothing curve fitting (penalized spline method), subgroup analysis and Kaplan–Meier survival curve analysis.ResultsDuring a median follow-up of 1.72 years, 157 all-cause deaths occurred. A U-shaped association was found between the LDL-C/HDL-C ratio and all-cause mortality. Patients were divided according to the quintiles of the LDL-C/HDL-C ratio. Compared to the reference group (Q3: 1.67–2.10), patients with both lower (Q1 and Q2) and higher (Q4 and Q5) LDL-C/HDL-C ratios had higher all-cause mortality (< 1.67: HR 1.81, 95% CI: 1.08–3.03; ≥2.10: HR 2.00, 95% CI: 1.18–3.39). Compared with the lower and higher LDL-C/HDL-C ratio groups, patients with LDL-C/HDL-C ratios of 1.67–2.10 had a significantly higher survival probability (log-rank P = 0.038).ConclusionsThe results suggest that there is a U-shaped association between the LDL-C/HDL-C ratio and all-cause mortality. Both lower and higher LDL-C/HDL-C ratios were associated with increased all-cause mortality in elderly hypertensive patients.
Highlights
The low-density lipoprotein cholesterol/high-density lipoprotein- cholesterol (LDL-C/high-density lipoprotein cholesterol (HDL-C)) ratio is an excellent predictor of cardiovascular disease (CVD)
When the LDL-C/HDL-C ratio was used as a continuous variable, there was no significant relationship between the LDL-C/HDL-C ratio and all-cause mortality in any of the three models
In model 2, both the low LDL-C/HDL-C ratio and high LDL-C/HDL-C ratio groups had relatively higher mortality (< 1.67: hazard ratio (HR) 1.81, 95% Confidence interval (CI): 1.08–3.03; ≥2.10: HR 2.00, 95% confidence interval (95% CI): 1.18–3.39)
Summary
The low-density lipoprotein cholesterol/high-density lipoprotein- cholesterol (LDL-C/HDL-C) ratio is an excellent predictor of cardiovascular disease (CVD). The leading causes of death worldwide include stroke and cardiovascular disease (CVD), both of which are associated with higher levels of low-density lipoprotein cholesterol (LDL-C) and lower levels of high-density lipoprotein cholesterol (HDL-C) [1, 2]. Some studies have suggested that the LDL-C/HDL-C ratio is positively associated with CVD [5,6,7,8], while others have found a negative correlation between the LDL-C/HDL-C ratio and all-cause mortality [9, 10] The reasons for these inconsistencies can be attributed to differences in the study population, follow-up, and study endpoints. The above studies proposed different ranges of the LDL-C/HDL-C ratio that were associated with the lowest risk of CVD or all-cause mortality. These factors prevent the LDL-C/HDL-C ratio from being a valuable predictor of all-cause mortality in clinical practice
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