A nonlinear relationship between the triglycerides to high-density lipoprotein cholesterol ratio and stroke risk: an analysis based on data from the China Health and Retirement Longitudinal Study

Shike Zhang; Changchun Cao; Yong Han; Haofei Hu; Xiaodan Zheng

doi:10.1186/s13098-024-01339-3

A nonlinear relationship between the triglycerides to high-density lipoprotein cholesterol ratio and stroke risk: an analysis based on data from the China Health and Retirement Longitudinal Study

Diabetol Metab Syndr. 2024 Apr 27;16(1):96. doi: 10.1186/s13098-024-01339-3.

Authors

Shike Zhang^#^{1

2}, Changchun Cao^#³, Yong Han^#⁴, Haofei Hu⁵, Xiaodan Zheng⁶

Affiliations

¹ Department of Rehabilitation, Shenzhen Yantian District People's Hospital, Shenzhen, 518000, Guangdong, China.
² Department of Rehabilitation, Southern University of Science and Technology Yantian Hospital, Shenzhen, 518000, Guangdong, China.
³ Department of Rehabilitation, Shenzhen Second People's Hospital, Shenzhen Dapeng New District Nan'ao People's Hospital, Shenzhen, 518000, Guangdong, China.
⁴ Department of Emergency, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, 518035, Guangdong, China.
⁵ Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, No. 3002, Sungang West Road, Futian District, Shenzhen, 518000, Guangdong, China. huhaofei0319@126.com.
⁶ Department of Neurology, Shenzhen Samii Medical Center (The Fourth People's Hospital of Shenzhen), No. 1, Jinniu West Road, Shijing Street, Pingshan District, Shenzhen, 518000, Guangdong, China. zhengxiaodan512@163.com.

^# Contributed equally.

Abstract

Objective: The connection between triglycerides to high-density lipoprotein cholesterol (TG/HDL-C) ratio and stroke risk is controversial. Our goal was to explore this relationship in individuals aged 45 and older enrolled in the China Health and Retirement Longitudinal Study (CHARLS).

Methods: Our analysis encompassed 10,164 participants from the CHARLS cohorts. We applied the Cox proportional-hazards regression model to evaluate the potential correlation between the TG/HDL-C ratio and stroke incidence. Using a cubic spline function and smooth curve fitting within the Cox model allowed us to unearth a possible non-linear pattern in this relationship. We also conducted thorough sensitivity and subgroup analyses to deepen our understanding of the TG/HDL-C ratio's impact on stroke risk.

Results: Adjusting for various risk factors, we observed a significant link between the TG/HDL-C ratio and increased stroke risk in individuals aged 45 and above (HR: 1.03, 95% CI 1.00-1.05, P = 0.0426). The relationship appeared non-linear, with an inflection at a TG/HDL-C ratio of 1.85. Ratios below this threshold indicated a heightened stroke risk (HR: 1.28, 95% CI 1.06-1.54, P = 0.0089), while ratios above it did not show a significant risk increase (HR: 1.01, 95% CI 0.98-1.04, P = 0.6738). Sensitivity analysis confirmed the robustness of these findings. Notably, non-smokers exhibited a stronger correlation between the TG/HDL-C ratio and stroke risk compared to past and current smokers.

Conclusion: Our investigation revealed a significant, yet non-linear, association between the TG/HDL-C ratio and the incidence of stroke among individuals aged 45 and above. Specifically, we found that stroke risk increased in correlation with TG/HDL-C ratio below the threshold of 1.85. These insights may guide healthcare providers in advising and developing more effective strategies for stroke prevention in this demographic.

Keywords: High-density lipoprotein cholesterol; Nonlinearity; Stroke; Triglycerides; Triglycerides-to-high-density lipoprotein cholesterol ratio.