ArticleTobacco induced diseases2026
Association of the high-density lipoprotein cholesterol to C-reactive protein ratio with chronic cough in US adults: Effect modification by smoking status.
Article in Tobacco induced diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionSystemic inflammation may mediate the association between chronic cough and lipid metabolism. The high-density lipoprotein cholesterol to C-reactive protein (HDL-C/CRP) ratio, a composite marker of metabolic-inflammatory balance, has not been evaluated in this context. Smoking impairs high-density lipoprotein (HDL) function and elevates CRP, yet the combined effect of these pathways on chronic cough remains unknown. This study examined the association between the HDL-C/CRP ratio and chronic cough in US adults, and assessed whether smoking status modified this association.
methodsThis secondary analysis study used cross-sectional data from the 2005-2010 National Health and Nutrition Examination Survey (NHANES). Chronic cough was defined as a recurrent cough on most days for ≥3 consecutive months per year (self-reported). Serum HDL-C and CRP were measured by standardized assays. Multivariate logistic regression was employed to assess the association between the natural logarithm of the ratio of HDL-C to CRP [Ln (HDL-C/CRP)] and chronic cough. Subgroup analyses examined the interaction with smoking status, and sensitivity analyses validated the robustness of our findings. Nonlinear relationships were assessed using restricted cubic splines (RCS).
resultsThe study enrolled 6762 participants, 672 of whom had chronic cough. After full adjustment, each unit increase in the Ln (HDL-C/CRP) was associated with a 13% lower risk of chronic cough (AOR=0.87; 95% CI: 0.78-0.97). RCS showed a linear relationship and negative correlation between Ln (HDL-C/CRP) and chronic cough (p for nonlinearity=0.779, p for overall=0.021). Subgroup analysis showed the association varied across smoking status groups (interaction p=0.005), with the most pronounced association observed among never smokers (OR=0.735; 95% CI: 0.602-0.898).
conclusionsThis cross-sectional study demonstrates that a higher HDL-C/CRP ratio is associated with a lower prevalence of chronic cough, exhibiting a linear dose-response relationship. Notably, this association is most pronounced in never smokers, suggesting a potential modifying effect of smoking status.
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