Journal of clinical lipidology · 2026
Predictive value of LDL/HDL cholesterol ratio for new-onset stroke in individuals with cardiovascular-kidney-metabolic syndrome stages 0 to 3: Evidence from the China Health and Retirement Longitudinal Study.
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Xie Linfeng, Fan Hongyi, Luo Suxin, Huang Bi
Аннотация
BACKGROUND: The association between low-density lipoprotein to high-density lipoprotein (LDL/HDL) ratio and incident stroke among individuals with cardiovascular-kidney-metabolic (CKM) syndrome stages 0 to 3 remains unclear.
OBJECTIVE: To examine the relationship of baseline and cumulative LDL/HDL ratio with new-onset stroke in CKM stages 0 to 3.
METHODS: Data were obtained from the China Health and Retirement Longitudinal Study between 2011 and 2020. Individuals with CKM syndrome stages 0 to 3 were included to evaluate the relationship between baseline and cumulative LDL/HDL ratio and new-onset stroke.
RESULTS: A total of 7867 participants were included. During follow-up, 501 individuals (6.4%) developed incident stroke. Stroke incidence increased progressively across LDL/HDL quartiles (Q1-Q4: 4.5%, 5.5%, 7.5%, and 7.9%, respectively; P < 0.001). Multivariate Cox regression demonstrated significantly elevated new-onset stroke risk in higher quartiles (Q3 vs. Q1: hazard ratio [HR] = 1.456, 95% CI 1.110-1.910, P = 0.007; Q4 vs. Q1: HR = 1.373, 95% CI 1.044-1.805, P = 0.023). Subgroup analyses confirmed the consistency of these associations. Mediation analyses indicated that systolic blood pressure (17.53%), glucose (6.67%), waist circumference (26.30%), and body mass index (20.60%) partially mediated the relationship. Additionally, a higher cumulative LDL/HDL ratio was associated with increased stroke risk (Q4 vs. Q1: HR =1.540, 95% CI 1.127-2.104, P = 0.007).
CONCLUSION: Both baseline and cumulative LDL/HDL ratios were significantly correlated with an increased risk of new-onset stroke. Early identification and intervention of elevated LDL/HDL ratios may mitigate new-onset stroke risk in individuals with CKM syndrome.
OBJECTIVE: To examine the relationship of baseline and cumulative LDL/HDL ratio with new-onset stroke in CKM stages 0 to 3.
METHODS: Data were obtained from the China Health and Retirement Longitudinal Study between 2011 and 2020. Individuals with CKM syndrome stages 0 to 3 were included to evaluate the relationship between baseline and cumulative LDL/HDL ratio and new-onset stroke.
RESULTS: A total of 7867 participants were included. During follow-up, 501 individuals (6.4%) developed incident stroke. Stroke incidence increased progressively across LDL/HDL quartiles (Q1-Q4: 4.5%, 5.5%, 7.5%, and 7.9%, respectively; P < 0.001). Multivariate Cox regression demonstrated significantly elevated new-onset stroke risk in higher quartiles (Q3 vs. Q1: hazard ratio [HR] = 1.456, 95% CI 1.110-1.910, P = 0.007; Q4 vs. Q1: HR = 1.373, 95% CI 1.044-1.805, P = 0.023). Subgroup analyses confirmed the consistency of these associations. Mediation analyses indicated that systolic blood pressure (17.53%), glucose (6.67%), waist circumference (26.30%), and body mass index (20.60%) partially mediated the relationship. Additionally, a higher cumulative LDL/HDL ratio was associated with increased stroke risk (Q4 vs. Q1: HR =1.540, 95% CI 1.127-2.104, P = 0.007).
CONCLUSION: Both baseline and cumulative LDL/HDL ratios were significantly correlated with an increased risk of new-onset stroke. Early identification and intervention of elevated LDL/HDL ratios may mitigate new-onset stroke risk in individuals with CKM syndrome.