Abstract
BACKGROUND: Previous research has explored the association between the ratio of high-density lipoprotein cholesterol to C-reactive protein (HDL-C/CRP) and the mortality risk in individuals with heart failure. This study aims to investigate the correlation between HDL-C/CRP ratio and all-cause mortality through the analysis of extensive data derived from the general public. METHODS: This study analyzed NHANES data and surveyed 28,544 adults from America. Survival outcomes were evaluated using Kaplan-Meier curves, while a survey-weighted multivariable Cox proportional hazards model was employed. Restricted cubic splines (RCS) and hierarchical analysis were used to investigate associations and interactions, respectively. Additionally, the ability of lnHDL-C/CRP to predict all-cause death was assessed using receiver operating characteristic curves. RESULTS: During a mean follow-up period of 156.5 months, 5965 (20.9%) died from any cause. Weighted RCS analysis revealed an L-shaped association between HDL-C/CRP ratio and all-cause mortality. Below a lnHDL-C/CRP of 6.65 (HDL-C/CRP ratio of 773), the likelihood of all-cause death decreased by 14% with every 1-point rise in lnHDL-C/CRP [HR (95% CI) 0.86 (0.81, 0.90)]. Including lnHDL-C/CRP in the baseline risk model significantly enhanced its predictive power for mortality. Consistent findings were observed in subgroups, with individuals under 60 years or with a BMI over 30 showing a stronger correlation between HDL-C/CRP ratio and overall mortality risk. CONCLUSIONS: The association between HDL-C/CRP ratio and overall mortality in the general US adult population is non-linear, particularly significant in adults under 60 years old and obese individuals. HDL-C/CRP ratio could be regarded as a potential marker for assessing mortality risk.