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. 2025 Jul 25;20(1):311.
doi: 10.1186/s13019-025-03551-2.

Association of outcome with non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio in hospitalized patients with congestive heart failure: a retrospective analysis

Lina Yu  1 , Lianhong Xie  2
Affiliations

Association of outcome with non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio in hospitalized patients with congestive heart failure: a retrospective analysis

Lina Yu et al. J Cardiothorac Surg. .

Abstract

Objective: To investigate the association between the Non-HDL cholesterol to HDL cholesterol ratio (NHHR) and all-cause mortality in patients with congestive heart failure (CHF) and to determine whether NHHR levels influence the prognosis of CHF patients.

Methods: The study participants were stratified based on the quartiles of NHHR. Kaplan-Meier (KM) curves, multivariate Cox regression analysis, and restricted cubic spline (RCS) analysis were employed to determine whether the prognosis of CHF patients varied according to NHHR levels.

Results: Our study included 2156 patients, of whom 274 (12.7%) died during hospitalization, 337 (15.6%) within 28 days, 480 (22.3%) within 90 days, and 665 (30.8%) within one year. Restricted cubic spline (RCS) analysis revealed a distinct U-shaped association between NHHR levels and mortality in CHF patients, characterized by an initial rapid decline followed by a gradual increase in mortality risk. Notably, patients in the lowest NHHR quartile (Q1) demonstrated significantly elevated 28-day, 90-day, and 1-year mortality rates (all P < 0.01, as confirmed by the Log-rank test) compared to the lower three quartiles, as confirmed by log-rank tests. Following the adjustment for confounding variables, multivariate Cox regression analysis established a substantial correlation between NHHR and all-cause mortality in CHF patients.

Conclusion: A virtually U-shaped link exists between NHHR and all-cause mortality in CHF patients, and further study is needed to corroborate this finding.

Keywords: Heart failure; Intensive care unit; Mortality; NHHR; Prognosis.

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Conflict of interest statement

Declarations. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The potential non-linear relationship between NHHR and all-cause mortality in patients with CHF was evaluated using a restricted cubic spline analysis. (A) A multiple-variable adjusted restricted cubic spline method was used to illustrate the relationship between NHHR levels and hospital mortality in CHF patients; (B) A multiple-variable adjusted restricted cubic spline method was used to depict the relationship between NHHR levels and 28-day mortality in CHF patients; (C) A multiple-variable adjusted restricted cubic spline method was used to show the relationship between NHHR levels and 90-day mortality in CHF patients; (D) A multiple-variable adjusted restricted cubic spline method was used to demonstrate the relationship between NHHR levels and 1-year mortality in CHF patients. A restricted cubic spline analysis was used to evaluate the potential nonlinear relationship between NHHR and all-cause mortality in CHF patients, with an NHHR of 2.35 selected as the reference estimate for all-cause mortality. The shaded area represents the 95% confidence interval (CI). HR: hazard ratio; CI: confidence interval; NHHR: non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio
Fig. 2
Fig. 2
Kaplan-Meier survival curve for mortality according to NHHR. (A) Kaplan-Meier survival curve for hospital mortality according to NHHR; (B) Kaplan-Meier survival curve for 28-d mortality according to NHHR; (C) Kaplan-Meier survival curve for 90-d mortality according to NHHR; (D) Kaplan-Meier survival curve for 1 year mortality according to NHHR. NHHR: non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio. Q1 (NHHR < 1.80), Q2 (NHHR 1.80–2.35), Q3 (NHHR 2.35–3.28), and Q4 (NHHR > 3.28)
Fig. 3
Fig. 3
Subgroup analyses for the correlation of NHHR with risk of 1 year mortality HR: odds ratio, CI: confidence interval
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