The relationship between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and abdominal aortic calcification in adults: a cross-sectional study.

Background: The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is a novel lipid index for assessing atherosclerosis. Although NHHR has been recognized as a biomarker for multiple diseases, its association with abdominal aortic calcification (AAC) remains unexplored. Methods: This study analyzed data from 2,517 participants in the 2013 to 2014 National Health and Nutrition Examination Survey (NHANES). AAC was assessed using dual-energy x-ray absorptiometry and quantified with the Kauppila score (AAC-24). The relationship between NHHR and AAC was evaluated using multivariate linear and logistic regression models, with nonlinear associations visualized via restricted cubic splines. Subgroup and interaction analyses were conducted to assess the robustness of the findings across different populations. Results: In fully adjusted models, AAC scores and severe AAC (sAAC) prevalence increased with each quartile increment of NHHR (p < 0.05). A one-unit increase in NHHR was associated with a 0.13-unit rise in AAC score (β = 0.13, 95% CI: 0.02-0.24) and a 19% increase in sAAC risk (OR = 1.19, 95% CI: 1.02-1.40). Subgroup analysis identified a significant interaction between NHHR and gender in relation to AAC. The OR (95% CI) was 0.97 (0.77-1.23) in males and 1.46 (1.18-1.81) in females (p for interaction = 0.008). Conclusion: In adults aged 40 years and older, higher NHHR levels were associated with increased AAC scores and a greater risk of sAAC, particularly among women. Furthermore, this study highlights the potential clinical value of NHHR in the prevention of AAC and its related complications.