J-shaped association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and heart failure: a cross-sectional study

AIMS: Non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR), a burgeoning lipid parameter, demonstrates significant predictive value for atherosclerotic and metabolic diseases. However, the correlation of NHHR with heart failure (HF) is still not well established. METHODS: Between 2011 and 2018, this study analyzed NHHR and HF data from 11,639 individuals in the National Health and Nutrition Examination Survey. The relationship between HF and NHHR was examined using a multivariate logistic regression model. Results were graphically represented through restricted cubic splines (RCS) model, and threshold effects were evaluated. To further explore the non-linear association, piecewise logistic regression analysis was conducted. Moreover, to confirm the stability of the findings, sensitivity and subgroup analyses were undertaken. RESULTS: Among the entire cohort, 433 patients (3.7%) suffered from HF, with a mean age of 47.12 years, a male proportion of 50.6%, and a hypertension prevalence of 30.9%. Multivariate logistic regression analysis indicated notable correlations between HF risk and both the lowest and highest NHHR levels [(NHHR < 2.0 vs. 2.0 ≤ NHHR < 3.0), odds ratio (OR) = 1.693, 95% confidence interval (CI) 1.270 to 2.257; (NHHR ≥ 5.0 vs. 2.0 ≤ NHHR < 3.0), OR = 2.591, 95% CI 1.707 to 3.932], which were also supported by subgroup and sensitivity analyses. The RCS model showed the J-shaped relationship between NHHR and HF, characterized by a risk inflection point at 2.58. Piecewise logistic regression analysis demonstrated significant associations between HF risk and NHHR on both sides (< 2.58 and ≥ 2.58) [OR = 0.545, 95% CI 0.394 to 0.755; OR = 1.132, 95% CI 1.040 to 1.232]. CONCLUSION: Both lowest and highest levels of NHHR were significantly associated with HF risk in the United States adults. Moreover, a J-shaped relationship was observed between NHHR and HF risk, with an inflection point at 2.58.