Association Between Non‐High‐Density Lipoprotein Cholesterol and High‐Density Lipoprotein Cholesterol Ratio With Albuminuria: A Cross‐Sectional <scp>NHANES</scp> Study

The non-high-density lipoprotein cholesterol (non-HDL-c) to high-density lipoprotein cholesterol (HDL-c) ratio (NHHR) is an emerging and valuable biomarker for cardiovascular disease risk. Nevertheless, robust evidence regarding its relationship with both the prevalence and severity of albuminuria remains incompletely elucidated. This cross-sectional study analyzed data from the 1999 to 2018 US National Health and Nutrition Examination Survey to investigate the association between NHHR and albuminuria, assessed via the urinary albumin-to-creatinine ratio (uACR). Multivariate logistic and linear regression models, restricted cubic spline analysis, subgroup analyses and receiver-operating characteristic curve analysis were employed. Among the 14,376 participants included, the prevalence of microalbuminuria and macroalbuminuria was 6.83% and 1.06%, respectively. The adjusted odds ratios (95% confidence intervals) for each one-unit increase in NHHR were 1.09 (1.04-1.15) for any albuminuria, 1.06 (1.01-1.12) for microalbuminuria, and 1.23 (1.11-1.37) for macroalbuminuria. NHHR was positively correlated with uACR (β = 4.08, 95% confidence interval 1.11-7.04). Restricted cubic spline analysis revealed a positive association, which became more pronounced at NHHR levels exceeding 2.77. Subgroup analyses further demonstrated that this association was stronger in individuals with a body mass index ≥ 30 kg/m² or an estimated glomerular filtration rate ≥ 90 mL/min/1.73 m². Receiver-operating characteristic curve analysis confirmed that NHHR possessed superior discriminative power for albuminuria compared to conventional lipid parameters of total cholesterol, HDL-c, non-HDL-c, triglycerides, and apolipoprotein B. We concluded that elevated NHHR is positively and independently associated with an increased risk and severity of albuminuria, highlighting its clinical relevance as a potential biomarker, particularly among individuals with obesity and preserved renal function.