Non–HDL to HDL cholesterol ratio and coronary outcomes in U.S. adults: a cross-sectional and prospective NHANES analysis

In this large NHANES-based observational study, NHHR was cross-sectionally associated with lower CHD prevalence and longitudinally associated with reduced mortality. While similar patterns have been reported in prior NHANES studies, our analysis contributes additional insight by jointly modeling both CHD and mortality outcomes using nonlinear spline approaches and subgroup analyses. The paradoxical inverse association with CHD may reflect residual confounding or reverse causality. These findings remain exploratory and require cautious interpretation and further validation.