ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Cardiovascular Endocrinology
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1657213
This article is part of the Research TopicHypertension and Endocrine Pathways: Molecular and Clinical PerspectivesView all articles
Association between LDL-C/HDL-C ratio and first stroke in hypertensive patients: a prospective cohort study
Provisionally accepted
- 1Nanchang University Second Affiliated Hospital, Nanchang, China
- 2Jiangxi Science and Technology Normal University, Nanchang, China
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Background: Existing evidences regarding the association between the ratio of low-density lipoprotein cholesterol (LDL-C) to high-density lipoprotein cholesterol (HDL-C) and first stroke in hypertensive patients remains limited. This study aims to assess the role of LDL-C/HDL-C ratio in the risk of first stroke in Chinese hypertensive patients. Methods and results: This prospective cohort study encompassed 12, 893 hypertensive patients from the Chinese Hypertension Registry. Cox proportional hazards regression, restricted cubic spline (RCS), and subgroup analysis were applied to evaluate the association between LDL-C/HDL-C ratio and first stroke. The hazard ratio (HR) and 95% confidence interval (CI) were used to estimate the strength of the association. The mean age of all participants was 63.7 ± 9.5 years , and 531 cases of first stroke occurred, with an average follow-up time of 3.9 years. In the fully adjusted model, each 1-unit increame of LDL-C/HDL-C ratio raised the risk of first stroke by 43% (HR=1.43, 95% CI: 1.22–1.67). Compared with patients in the Q1 of LDL-C/HDL-C ratio, the adjusted HRs of stroke for those in Q2, Q3, and Q4 were respectively 1.32 (95% CI: 1.03,1.70), 1.49 (95% CI: 1.14, 1.96), and 1.94 (95% CI: 1.45, 2.59), with a statistically significant trend (P for trend < 0.001). Analyses using restricted cubic spline confirmed the linear association between the LDL-C/HDL-C ratio and first stroke. Subgroup analysis revealed a stronger association between the LDL-C/HDL-C ratio and first stroke in drinkers (P for interaction=0.024). Conclusion: A high LDL-C/HDL-C ratio may increase the risk of first stroke in hypertensive patients, especially among current drinkers.
Keywords: Hypertension, LDL-C/HDL-C ratio, First stroke, cohort study, Alcohol Drinking
Received: 01 Jul 2025; Accepted: 25 Aug 2025.
Copyright: © 2025 Yu, Wu, Zhu, Wang, Zhang, Wei, Bao and Cheng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Weifang Zhang, Nanchang University Second Affiliated Hospital, Nanchang, China
Zhou Wei, Nanchang University Second Affiliated Hospital, Nanchang, China
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