Association of total cholesterol to high-density lipoprotein cholesterol ratio with diabetes risk: a retrospective study of Chinese individuals

• Published in: Scientific reports Vol. 15; no. 1; pp. 16261 - 10
• Main Authors: Zhang, Zhiqiang, Chen, Hejun, Chen, Lei, Liang, Wenyan, Hu, Tenglong, Sun, Na, Zhao, Yangyu, Wei, Xiqing
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 09.05.2025; Nature Publishing Group; Nature Portfolio
• Subjects: 692/163; 692/308; Adult; Aged; Asian People; China - epidemiology; Cholesterol; Cholesterol - blood; Cholesterol, HDL - blood; Cohort study; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - epidemiology; East Asian People; Female; Health risks; High density lipoprotein; Humanities and Social Sciences; Humans; Hypercholesterolemia; Lipoproteins; Male; Middle age; Middle Aged; multidisciplinary; Regression analysis; Retrospective Studies; Risk factor; Risk Factors; Science; Science (multidisciplinary); TC/HDL-C; Total cholesterol: high-density lipoprotein cholesterol ratio; China; TC/HDL-C; Diabetes; Total cholesterol: high-density lipoprotein cholesterol ratio; Cohort study; Risk factor
• DOI: 10.1038/s41598-025-87277-0
• ISSN: 2045-2322

A common complication of type 2 diabetes is hypercholesterolemia in many patients. It is still unclear, nevertheless, how high-density lipoprotein cholesterol ratio (TC/HDL-C), total cholesterol, and diabetes are related. The purpose of this study is to look at the prediction ability and causal relationship between TC/HDL-C and diabetes. This study included 117,268 subjects who were undergoing physical examinations. The subjects were grouped into four equal groups according to the TC/HDL-C quartiles; the main outcome was the occurrence of diabetes events. TC/HDL-C is calculated as total cholesterol divided by high-density lipoprotein cholesterol. In 3.1 years (± 0.95) of follow-up, 795 women (0.68%) and 1,894 men (1.62%) received new diabetes diagnoses. TC/HDL-C is an independent predictor of new-onset diabetes, according to multivariable Cox regression analysis (HR 1.27 per SD increase, 95% CI: 1.09–1.48, P for trend < 0.001). It turned out that a cutoff value of 3.55 (area under the curve 0.64, sensitivity 0.66, specificity 0.56), was ideal for TC/HDL-C in predicting new-onset diabetes. A subgroup analysis demonstrated that the younger population had a significantly higher risk of TC/HDL-C-related diabetes than the middle-aged group (interaction P  < 0.05). After controlling for confounding variables, this Chinese cohort study reveals a direct correlation between TC/HDL-C and diabetes, with a stronger independent association observed in younger and middle-aged individuals.