Association of non-HDL-C/HDL-C ratio and its dynamic changes with incident type 2 diabetes mellitus: The Rural Chinese Cohort Study

Background: We aimed to evaluate the association of the ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (non-HDL-C/HDL-C) and its dynamic changes with incident type 2 diabetes mellitus (T2DM). Methods: A total of 11,487 nondiabetic participants >= 18 years old in rural China were recruited in 2007-2008 and followed up in 2013-2014. A Cox proportional-hazards model was used to assess the risk of incident T2DM by quartiles of baseline non-HDL-C/HDL-C ratio and dynamic absolute and relative changes in non-HDL-C/HDL-C ratio, estimating hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Risk of incident T2DM was increased with quartiles 2, 3, and 4 versus quartile 1 of baseline non-HDL-C/ HDL-C ratio (HR 1.46 [95% CI 1.08-1.98], 1.51 [1.12-2.03], and 2.16 [1.62-2.88], P-trend < 0.001). As compared with stable non-HDL-C/HDL-C ratio during follow-up, an absolute gain in non-HDL-C/HDL-C ratio was associated with increased risk of T2DM (HR 1.67 [95% CI 1.25-2.24] for quartile 3 and 2.00 [1.52-2.61] for quartile 4). A relative increase in non-HDL-C/HDL-C ratio was also associated with increased risk of T2DM (HR 1.56 [95% CI 1.19-2.04] for quartile 3 and 1.97 [1.49-2.60] for quartile 4). Subgroup analyses showed that the association of non-HDL-C/ HDL-C ratio with T2DM risk remained consistent. Conclusions: Increased non-HDL-C/HDL-C ratio is associated with increased risk of incident T2DM among rural Chinese adults, so the index may be an important indicator for identifying individuals at T2DM risk. (c) 2020 Elsevier Inc. All rights reserved.