Association of Non-High-Density Lipoprotein Cholesterol to High-Density Lipoprotein Cholesterol Ratio (NHHR) with Cardiovascular-Kidney-Metabolic (CKM) Syndrome Stages: Evidence from a Nationally Representative U.S. Cohort (NHANES 2005-2018)

BackgroundThe Non-HDL-C/HDL-C ratio (NHHR) is an emerging lipid marker, but its role in Cardiovascular-Kidney-Metabolic (CKM) syndrome remains unclear. ObjectiveThis study investigated NHHRs association with CKM stages in a U.S. cohort. MethodsA total of 14638 participants were included out of 51,199 from the NHANES 2005-2018 survey. Analyzed using a survey weighting approach to ensure a nationally representative sample. The connection of NHHR with CKM syndrome was assessed via multivariate logistic regression, restricted cubic splines (RCS), and subgroup analyses. The predictive performance of NHHR across different CKM stages was assessed via the Receiver operating characteristic (ROC) curve. ResultsThe NHHR level in patients with CKM syndrome was higher than in patients without (2.87{+/-}1.14 vs 2.35{+/-}0.93 mg/dL, P<0.001). The multivariate logistic regression analysis suggested a positive connection between NHHR and CKM syndrome. The RCS analysis revealed a nonlinear association between the NHHR and CKM syndrome (nonlinear p < 0.001). ROC curve analysis demonstrated that NHHR had the best discriminatory ability for CKM stage 2 (area under the curve 0.673). Subgroup analyses revealed that age, race, and education significantly influenced the connection between NHHR and CKM syndrome. ConclusionThis research confirmed that NHHR was positively correlated with CKM syndrome and had the best predictive ability for CKM stage 2, suggesting that NHHR may assist in the early diagnosis and intervention of CKM syndrome.