Lymphocyte-to-high-density lipoprotein cholesterol ratio and prevalent carotid artery plaque in adults undergoing routine health examinations: a cross-sectional study

The lymphocyte-to-high-density lipoprotein cholesterol ratio (LHR) combines an immune-cell count with a lipid measure, but evidence on its association with carotid artery plaque (CAP) remains limited. We examined the association between LHR and prevalent CAP among adults undergoing routine health examinations. This single-center cross-sectional study included 10,925 adults who underwent health examinations and carotid ultrasonography at Northern Jiangsu People’s Hospital between January 1, 2024, and August 31, 2025. LHR was calculated by dividing the absolute lymphocyte count by the serum high-density lipoprotein cholesterol concentration. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for demographic, lifestyle, and cardiometabolic factors, including dyslipidemia and lipid-lowering medication use. Associations were assessed per 1-unit and 1-standard deviation (SD) increase and across LHR quartiles. Subgroup and sensitivity analyses were also performed. The median age was 53 years (interquartile range [IQR], 45–60), 48.81% of participants were men, and 2,863 (26.21%) had CAP. The median LHR was 1.56 (IQR, 1.18–2.10), with a mean of 1.71 (SD, 0.76) and a range of 0.24–7.28. In the fully adjusted model, each 1-unit increase in LHR was associated with higher odds of prevalent CAP (OR, 1.13; 95% CI, 1.04–1.21); the corresponding OR per 1-SD increase was 1.09 (95% CI, 1.03–1.16). The adjusted association was approximately linear. The association differed by age (P for heterogeneity < 0.001): the OR per 1-unit increase was 1.23 (95% CI, 1.08–1.39) among participants aged ≥ 60 years ( n = 2,906) and 0.91 (95% CI, 0.83–1.00) among those aged < 60 years ( n = 8,019). Estimates were similar across sensitivity analyses. Higher LHR was associated with prevalent CAP after multivariable adjustment, with a stronger positive association among adults aged ≥ 60 years in exploratory subgroup analyses. These findings support further investigation of LHR in relation to subclinical carotid atherosclerosis. Prospective studies are needed to clarify the temporal relationship and assess its potential clinical relevance.