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.

PURPOSE: Chronic obstructive pulmonary disease (COPD) poses a growing public health burden in China, yet reliable biomarkers for risk stratification remain limited. The non–high-density lipoprotein cholesterol (non–HDL-C) to high-density lipoprotein cholesterol (HDL-C) ratio (NHHR) has recently been proposed as an integrated lipid index, but its association with COPD is unclear in Asian populations. PATIENTS AND

METHODS

We analyzed data from 11,082 adults aged ≥ 45 years in the 2015 wave of the China Health and Retirement Longitudinal Study (CHARLS). COPD was defined by physician diagnosis. NHHR was calculated as (total cholesterol (TC) – HDL-C)/HDL-C. Logistic regression models, restricted cubic splines, and subgroup analyses were used to evaluate the association between NHHR and COPD. A predictive nomogram was developed and validated using receiver operating characteristic (ROC) and calibration analyses.

RESULTS

Overall, 16.9% (n = 1,601) of participants had COPD. In fully adjusted models, higher NHHR was significantly associated with a lower risk of COPD (highest vs. lowest quartile: OR = 0.75, 95% CI: 0.64–0.89, P < 0.001). The inverse association was linear and consistent across most subgroups, particularly in older adults and those with hypertension, diabetes, or chronic kidney disease (CKD). In multivariable feature selection, NHHR, male sex, older age, lower education, cardiovascular disease (CVD), and CKD were independent predictors of COPD. A nomogram incorporating these predictors demonstrated moderate discrimination (area under the curve, AUC = 0.67) and good calibration.

CONCLUSIONS

NHHR is inversely associated with COPD prevalence among middle-aged and older Chinese adults and may serve as a simple lipid-based biomarker for risk stratification. These findings highlight the potential role of lipid metabolism in COPD pathogenesis. The NHHR-based predictive model appears to hold potential clinical value for the prevention of COPD.