Associations of the hs-CRP/HDL-C ratio with cardiovascular disease among US adults: Evidence from NHANES 2015-2018.

Background and aims: Inflammation, lipid signaling, and their interplay are involved in the pathogenesis and development of cardiovascular diseases (CVDs), while the relationships of composite indices combining inflammation and lipids with CVD remained inexplicit.

Methods and results: Our study enrolled 8581 adults from the National Health and Nutrition Examination Survey 2015-2018. Logistic regression model was applied to assess the associations of high-sensitivity C-reactive protein (hs-CRP)-to-high-density lipoprotein cholesterol (HDL-C) ratio with CVD prevalence. Potential mediating effects of hypertension, diabetes, hypercholesterolemia, and obesity on significant associations were explored. Receiver operating characteristic (ROC) curves were generated to compare diagnostic values of the hs-CRP/HDL-C ratio, HDL-C, and hs-CRP. Compared with those in the first quartile of the hs-CRP/HDL-C ratio, participants in the fourth quartile presented higher risks of CVD subtypes and total CVD. Each one-unit increment of the log-transformed hs-CRP/HDL-C ratio was associated with a 25 % increase in CVD risk (95 % confidence interval: 1.11, 1.41) with significant uptrends across the hs-CRP/HDL-C ratio quartiles. Four metabolic disorders significantly mediated associations of the hs-CRP/HDL-C ratio with CVDs. Younger participants were more sensitive to higher hs-CRP/HDL-C ratio with significant interactions in CVD. ROC curves further illustrated the relatively good diagnostic efficacy of the hs-CRP/HDL-C ratio for CVD.

Conclusion: The hs-CRP/HDL-C ratio was a significant risk factor for CVD among US adults, in which hypertension, diabetes, hypercholesterolemia, and obesity played important mediating roles. Early attention to people with elevated hs-CRP/HDL-C ratio would be helpful for CVD risk reduction.