High-Sensitivity C-Reactive Protein/High-Density Lipoprotein Cholesterol Ratio Predicts Long-Term Mortality

The ratio of high-sensitivity C-reactive protein (hs-CRP) to high-density lipoprotein cholesterol (HDL-C) predicts the long-term mortality of the general population independent of confounding factors, according to results of a study published in BMC Cardiovascular Disorders.¹

High Sensitivity C-Reactive Protein, High-Density Lipoprotein Cholesterol, All-Cause Mortality | Image Credit: SK imagine | stock.adobe.com

In another study published in the International Heart Journal, investigators analyzed whether hs-CRP, a biomarker of pro-inflammation, and HDL-C, an anti-atherosclerosis component, could be combined as a biomarker for coronary artery disease (CAD) in comparison with neutrophil lymphocyte ratio and other biomarkers. They found that hs-CRP/HDL-C was significantly associated with CAD and could be an independent predictor of CAD.²

Furthermore, according to the current study authors, hs-CRP/HDL-C was associated with the occurrence of new cardiovascular-related diseases in middle-aged and elderly individual in China. However, data on the role in long-term all-cause and cardiovascular mortality are limited. The study authors aimed to evaluate the predictive value of this biomarker for long-term all-cause and cardiovascular-related mortality for adults in the general population in the United States.¹

In the study, investigators included data from the National Health and Nutrition Examination Survey, including data on fasting blood samples and quantification of hs-CRP and HDL-C in blood serum. Individuals responded to a demographic and health details survey, including medical history, smoking behaviors, alcohol consumption patterns, and concomitant medication at baseline. Individuals also reported hypertension, diabetes, heart failure, CAD, and stroke. The end points included all-cause and cardiovascular mortality.¹

Approximately 48.3% of the 9492 individuals were male and they had a median age of 47 years, according to the study authors. The median hs-CRP/HDL-C ratio was 0.38. During a median follow-up period of 37 months, there were 239 all-cause deaths, with 59 related to cardiovascular events. In the group with events (n = 239) individuals were older, mostly male, and had a greater presence of smokers. For all-cause mortality, cerebrovascular diseases and the use of lipid-lowering medications were more prevalent. Investigators reported a significantly higher hs-CRP an hs-CRP/HDL-C ratios in the group that experienced events.¹

For cardiovascular events, the population was similar, with mostly older and male patients, according to the study authors. There was also a higher incidence of hypertension, diabetes, heart failure, CAD, and stroke, as well as increased use of lipid-lowering medications. Investigators found that patients in the cardiovascular-related group had considerably higher hs-CRP/HDL-C ratios, resulting from higher serum of hs-CRP and lower HDL-C levels.¹

Investigators also tested for potential confounders, including age, sex, race, body mass index, drinking, smoking, and cardiovascular diseases. There was a substantial association between hs-CRP/HDL-C ratio and elevated risk of long-term mortality, with an increase in the ratio by 1 associated with a 9% risk of mortality. When the ratio was less than the inflection point of 1.21, the investigators reported that the risk of all-cause mortality was substantial, but after 1.21, the risk flattened out. For cardiovascular specifically, an increase in the ratio by 1 was associated with an 11% increase in risk of cardiovascular-related long-term mortality. When stratified by sex, age, drinking, and smoking, all subgroups, with the exception of non-drinkers, had a positive association between hs-CRP/HDL-C ratio and long-term all-cause mortality. Furthermore, a positive association was also seen for long-term cardiovascular mortality, with the exception of elderly individuals, females, and drinkers.¹

REFERENCES

1. Wang Y, Wang L, Zhao Z, Yin S, Tang X, Zhang K. The predictive role of the hs-CRP/HDL-C ratio for long-term mortality in the general population: evidence from a cohort study. BMC Cardiovasc Disord. 2024;24(1):758. Published 2024 Dec 30. doi:10.1186/s12872-024-04446-1

2. Luo H, Kou T, Yin L. High-Sensitivity C-Reactive Protein to HDL-C Ratio. Int Heart J. 2021;62(6):1221-1229. doi:10.1536/ihj.21-246