Objective  To investigate the relationship between non-high-density lipoprotein cholesterol (non-HDC-L) to high-density lipoprotein cholesterol (HDC-L) ratio (NHHR) and the risk of all- cause mortality in the population with abnormal glucose metabolism, and to provide a scientific basis for lipid management in patients with abnormal glucose metabolism.

Methods  Based on the 2011-2018 data of the China Health and Retirement Longitudinal Study, the relationship between NHHR and all-cause mortality risk was analyzed by restricted cubic spline and Cox proportional risk regression modeling in a population with abnormal glucose metabolism (including prediabetic and diabetic patients).

Results  A total of 6,300 study participants were enrolled, with 685 deaths during the 7-year follow-up period. The significant U-shaped nonlinear relationship was observed between NHHR and the risk of all-cause mortality in the population with abnormal glucose metabolism, with an inflection point value of 3.03 (nonlinear P=0.006). Each unit increase in NHHR was associated with a 21% reduction in the risk of all-cause mortality when NHHR<3.03 [HR=0.79, 95%CI (0.65, 0.95)], and a 5% increase in the risk of all-cause mortality when NHHR≥3.03 [HR=1.05, 95%CI (1.01, 1.08)]. Stratified analysis of NHHR tertiles showed that the middle tertile group (Tertile 2) had the lowest risk of all- cause mortality, and that both the lower tertile group (Tertile 1) and the higher tertile group (Tertile  3) had a significantly increased risk of mortality compared with the Tertile 2 group, with HRs of 1.26 [95%CI (1.05, 1.52)] and 1.23 [95%CI (1.01, 1.49)].

Conclusion  There was a significant U-shaped nonlinear relationship between NHHR and the risk of all-cause mortality in the population with abnormal glucose metabolism.

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