Association Between Neutrophil-to-High-Density Lipoprotein-Cholesterol Ratio and Coronary Artery Calcium: A Cross-Sectional Study

Background: Inflammation and lipid metabolism play critical roles in coronary artery calcium (CAC) progression. This study aimed to investigate the relationship between neutrophil-to-high-density lipoprotein-cholesterol ratio (NHR) and CAC score. Methods: This cross-sectional study included 2193 eligible participants from Sichuan Provincial People’s Hospital between November 2015 and July 2025. The correlation between NHR and CAC score was evaluated using multivariable logistic and multinomial logistic regression models. Restricted cubic splines (RCS) were employed to assess potential nonlinear relationships. Sensitivity analyses and subgroup analyses were performed to test the robustness of the findings. Results: Among 2193 eligible participants, 64.89% had detectable CAC. Higher NHR levels were significantly associated with increased CAC prevalence. After adjustment for multiple confounders, each 1-unit increase in NHR was associated with 9.0% higher odds of CAC (odds ratio (OR): 1.09, [95% confidence interval (CI) 1.03–1.16], p = 0.002). Compared with the lowest NHR quartile, the highest quartile was associated with modestly higher odds of CAC (OR: 1.43 [95% CI 1.05–1.95], p = 0.022). In multinomial analyses, NHR was modestly but significantly associated with CAC across mild, moderate, and severe calcification stages. The RCS analysis showed a linear relationship between NHR and CAC. Subgroup analyses and sensitivity analyses confirmed the robustness of the findings. Conclusions: Elevated NHR was associated with an increased likelihood of CAC. As a simple and readily available marker, NHR may reflect inflammatory and lipid metabolic status related to subclinical atherosclerosis, although its clinical utility requires further confirmation.