ArticleBMC medicine2024
The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) as a predictor of all-cause and cardiovascular mortality in US adults with diabetes or prediabetes: NHANES 1999-2018.
Article in BMC medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 118 papers.
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Who cites it
118 citing papers in PubMed.
- Article
- Differential pathway profiles of uric acid and the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) in predicting incident type 2 diabetes: a prospective cohort study.BMC endocrine disorders · 2026Article
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- Article
- Association between dietary magnesium intake and all-cause mortality in patients with chronic kidney disease: Insights from NHANES 1999-2018.Clinical medicine (London, England) · 2026Article
- Machine-Learning-Based Evaluation of the Prognostic Significance of the Non-High-Density Lipoprotein to High-Density Lipoprotein Cholesterol Ratio in Critical Ischemic Stroke.Medical science monitor : international medical journal of experimental and clinical research · 2026Article
- Decoding the lipid etiology of atherogenic index of plasma and gout: establishing the causal role of triglycerides through NHANES, Mendelian randomization, and network pharmacology.Cardiovascular diabetology. Endocrinology reports · 2026Article
- Association of the ratio of non-HDL-cholesterol to HDL-cholesterol with clinical and pathological characteristics in diabetic kidney disease.BMC nephrology · 2026Article
- Association between NHHR and depression symptoms among U.S. adults with hypertension: a cross sectional.BMC cardiovascular disorders · 2026Article
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- Article
- The neutrophil-percentage-to-albumin ratio (NPAR) shows a nonlinear correlation with all-cause mortality in patients with anemia.Clinical and experimental medicine · 2026Article
- GlycA as an Effect Modifier of Protein-Mortality Associations: A Prospective Cohort Study.Clinical and translational science · 2026Article
- Association of a novel triglyceride-glucose and non-HDL-to-HDL cholesterol ratio (TyG-NHHR) index with cardiometabolic multimorbidity: a dual-cohort prospective study in Chinese and European adults.Journal of health, population, and nutrition · 2026Article
- Association Between NHHR and Future Cardiovascular Disease Among Patients With CKM Stages 0-3: A Nationwide Prospective Cohort Study.Journal of clinical hypertension (Greenwich, Conn.) · 2026Article
- Potential Value of Novel Lipid-Derived Indicator as a Biomarker for Nonarteritic Anterior Ischemic Optic Neuropathy.Translational vision science & technology · 2026Article
- Non-HDL to HDL cholesterol ratio and coronary outcomes in U.S. adults: a cross-sectional and prospective NHANES analysis.European journal of medical research · 2026Article
- Association between non-HDL-cholesterol to HDL-cholesterol ratio (NHHR) and COPD: a cross-sectional study of 11,082 Chinese adults with predictive nomogram development.BMC pulmonary medicine · 2026Article
- Combining triglyceride‑glucose index and novel anthropometric measures to predict mortality risk in patients with T2DM: a prospective cohort study.BMC endocrine disorders · 2026Article
- J-shaped association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and heart failure: a cross-sectional study.European journal of medical research · 2026Article
58 more citing papers are in PubMed but not listed here.
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Authors and funding
8 authors.
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Abstract
backgroundThe non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) serves as a novel composite lipid indicator for atherosclerosis. However, the association between NHHR and mortality in patients with diabetes or prediabetes remains unclear. Consequently, the objective of this study was to investigate the relationship between NHHR and both all-cause and cardiovascular mortality in US adults with diabetes or prediabetes.
methodsThis study included 12,578 adult participants with diabetes or prediabetes from the US National Health and Nutrition Examination Survey (1999-2018). Mortality outcomes were ascertained by linking to the National Death Index (NDI) record up to December 31, 2019. We employed a weighted multivariate Cox proportional hazards model and restricted cubic splines to assess the associations between NHHR and all-cause and cardiovascular mortality. A segmented Cox proportional hazards model was used for evaluating threshold effects. Furthermore, a competing risks analysis was performed to explore the relationship between NHHR and cardiovascular mortality.
resultsDuring a median follow-up period of 8.08 years, 2403 participants encountered all-cause mortality, with 662 of them specifically succumbing to cardiovascular mortality. The restricted cubic splines revealed a U-shaped association between NHHR and all-cause mortality, while an L-shaped association was observed for cardiovascular mortality. The analysis of threshold effects revealed that the inflection points for NHHR and all-cause and cardiovascular mortality were 2.72 and 2.83, respectively. Specifically, when the baseline NHHR was below the inflection points, a negative correlation was observed between NHHR and both all-cause mortality (HR: 0.76, 95% CI: 0.68-0.85) and cardiovascular mortality (HR: 0.70, 95% CI: 0.57-0.85). Conversely, when the baseline NHHR exceeded the inflection points, a positive correlation was observed between NHHR and both all-cause mortality (HR: 1.11, 95% CI: 1.06-1.16) and cardiovascular mortality (HR: 1.08, 95% CI: 1.00-1.16).
conclusionsAmong US adults with diabetes or prediabetes, a U-shaped association was observed between NHHR and all-cause mortality, whereas an L-shaped association was identified with cardiovascular mortality. The inflection points for all-cause and cardiovascular mortality were 2.72 and 2.83, respectively.
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