# Association between fasting glucose/high-density lipoprotein cholesterol ratio and cardiovascular disease risk in Chinese middle-aged and older adults: a longitudinal study

## TL;DR

This study shows that the fasting glucose to HDL cholesterol ratio is a better predictor of cardiovascular disease in older Chinese adults than either measure alone.

## Contribution

The study introduces the FBG/HDL-C ratio as a novel, more effective predictor of CVD risk in middle-aged and older adults.

## Key findings

- A nonlinear association was found between the FBG/HDL-C ratio and CVD incidence.
- The highest diagnostic accuracy for CVD was achieved using the FBG/HDL-C ratio compared to FBG or HDL-C alone.
- Incorporating the FBG/HDL-C ratio improved CVD risk prediction in a basic model.

## Abstract

There is currently no information on the association between the fasting blood glucose/high-density lipoprotein cholesterol ratio (FBG/HDL-C) and cardiovascular disease (CVD) incidence.

Participants in our study, sourced from the China Health and Retirement Longitudinal Study, were grouped into quartiles by FBG/HDL-C ratio. CVD included self-reported heart disease and stroke. The ability of the FBG/HDL-C ratio to predict CVD was assessed using receiver operating characteristic (ROC) curves. Multivariate Cox regression was used to assess the association of FBG/HDL-C ratios with CVD, and potential nonlinear associations were explored using restricted cubic splines.

During the follow-up period from 2012 to 2018, 1,277 out of 6,995 participants (18.26%) developed CVD. There was a nonlinear association between the FBG/HDL-C ratio and CVD incidence in middle-aged and older adults (P for nonlinearity <0.05). Compared to the Q1 of the FBG/HDL-C ratio, the adjusted HRs and 95% CIs for CVD in the Q2 to Q4 were 1.17 (0.98–1.40), 1.41 (1.18–1.68), and 1.56 (1.28–1.90), respectively. ROC curve analysis showed that FBG/HDL-C ratio had the highest diagnostic accuracy for CVD than either FBG or HDL-C alone. Furthermore, incorporating the ratio of FBG/HDL-C into the basic model significantly enhanced the prediction of CVD risk.

We found that FBG to HDL-C ratio was significantly associated with an increased incidence of CVD in middle-aged and older adults. The FBG/HDL-C ratio was shown to be more effective in assessing cardiovascular risk than the use of FBG or HDL-C alone.