Association Between Platelet to High-Density Lipoprotein Cholesterol Ratio and Cardiometabolic Multimorbidity in Middle-Aged and Elderly Chinese Hypertensive Patients

Abstract

Hypertensive patients exhibit elevated risk for cardiometabolic multimorbidity (CMM). The platelet-to-high-density lipoprotein cholesterol ratio (PHR) has emerged as a biomarker for cardiovascular risk assessment. However, the precise relationship between PHR and CMM remains inconclusive. To assess the association between PHR and CMM risk among middle-aged and elderly Chinese hypertensive patients. We included patients with documented hypertension history using data from the China Health and Retirement Longitudinal Study. Participants were stratified into tertiles per baseline PHR. Logistic regression models examined the PHR-CMM risk association. To evaluate nonlinear relationships, restricted cubic splines (RCS) were built. Subgroup analyses were used to assess effect modification across population characteristics. Sensitivity analysis was performed by reclassifying participants into quartiles per baseline PHR. 4355 middle-aged and elderly Chinese hypertensive patients were included. Logistic regression showed that in the fully adjusted model, each one-standard-deviation (Per SD) increase in PHR was significantly associated with a 19% higher CMM risk (OR = 1.19, 95% CI: 1.06–1.32, p < 0.01). Compared with the lowest tertile group, patients in the highest PHR tertile exhibited a significantly increased CMM risk (OR = 1.76, 95% CI: 1.27–2.46, p < 0.001), with no significant nonlinear relationship (p for nonlinear = 0.613). PHR-CMM association showed no significant interaction across subgroups (p for interaction >0.05). Sensitivity analysis results were consistent with primary findings. Elevated PHR levels were associated with increased CMM risk among middle-aged and elderly Chinese hypertensive patients. Monitoring PHR may help predict CMM risk in elderly individuals with hypertension.