The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and the risk of ischemic heart disease in type 2 diabetes mellitus participants: a large-scale cohort study from the UK Biobank.

Abstract

Background: The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is a novel lipid indicator used for assessing the risk of cardiovascular diseases. This study was performed to explore the association between NHHR and the risk of ischemic heart disease (IHD) in type 2 diabetes mellitus (T2DM) patients.

Methods: This large-scale prospective cohort study included 19,925 participants from the UK Biobank. Cox proportional hazards regression models were used to assess the association between the NHHR and the risk of IHD in T2DM participants and restricted cubic spline (RCS) analysis was conducted to assess the dose-response association. Subgroup analysis and several sensitivity analyses were carried out to examine the robustness of our findings.

Results: During the follow-up (median 12.7 years), 3,600 T2DM participants developed IHD. The association between the NHHR and the risk of IHD in T2DM participants was significant in the highest NHHR quartile (quartile 4), whereas this association was not stable in quartile 2 or quartile 3. Four sensitivity analyses showed similar results. RCS analysis did not reveal a significant nonlinear relationship between the NHHR indicator and the risk of IHD in T2DM participants (P for nonlinearity = 0.9490). In the subgroup analysis, drinking status was found to have a joint effect with the NHHR on the incidence of IHD in T2DM patients (P for interaction = 0.038).

Conclusions: A high level of NHHR is associated with a high risk of IHD in T2DM patients, indicating the great importance of using NHHR in the lipid management of T2DM patients.