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Peer-reviewedCC BYEuropean Journal of Medical Research

U-shaped association of non-HDL-C/HDL-C ratio with atrial fibrillation recurrence postcatheter ablation: a cohort study

  • Mingjie Lin1
  • Naiyan Qiu2
  • Nan Yang1
  • Tongshuai Chen1
  • Bing Rong1
  • Wenqiang Han1
  • Maduray Kellina1
  • Jingquan Zhong1
  • Kai Zhang1
  1. 1Department of Cardiology, State Key Laboratory for Innovation and Transformation of Luobing Theory, Key Laboratory of Cardiovascular Remodeling and Function Research of Chinese Ministry of Education, Chinese National Health Commission, Chinese Academy of Medical Sciences and Shandong Province, Qilu Hospital of Shandong University
  2. 2Department of Cardiology, The Fifth People’s Hospital of Jinan
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Abstract

Background The prognostic value of lipid metrics in atrial fibrillation (AF) recurrence following catheter ablation (CA) remains controversial. This study investigated the prognostic value of the non-high-density lipoprotein-cholesterol/high-density lipoprotein-cholesterol ratio (NHHR) in predicting postablation AF recurrence. Methods In this cohort study, 1,728 patients with AF undergoing first-time CA at our center (2017–2020) were stratified by NHHR quartiles (Q1–Q4). The primary endpoint was AF recurrence and the secondary endpoint was incidence of Major Adverse Cardiovascular and Cerebrovascular Events (MACCEs) following CA. Results A U-shaped association was observed between the NHHR and AF recurrence (Pnonlinear = 0.021), with an inflection point at NHHR = 2.61, driven predominantly by an increased recurrence risk at lower NHHR values. Compared to the third quartile (Q3) (2.62–3.26), patients in the first NHHR quartile (Q1) had a 63.6% higher risk of recurrence (hazard ratio [HR] = 1.636, 95% confidence interval [CI]: 1.235–2.166). For NHHR < 2.61, the risk of recurrence risk decreased with an adjusted HR of 0.715 (95% CI, 0.524–0.977, P = 0.035) for every one-unit increment in the NHHR. The association for NHHR values above the inflection point was not statistically significant. Subgroup analyses confirmed consistency across age, sex, AF subtypes and duration, diabetes mellitus, CHA2DS2-VA scores, left atrial diameter, and non-PVI lesions (Pinteraction > 0.05). Sensitivity analysis further validated the temporal robustness of the association. NHHR demonstrated no association with MACCEs, underscoring its AF-specific prognostic value. Conclusions NHHR exhibited a U-shaped association with postablation AF recurrence, driven primarily by an increased risk at lower values. It may serve as a nonlinear lipid biomarker, with its role at the higher values requiring further investigation. Integration into clinical risk stratification is warranted, although therapeutic targeting requires additional mechanistic validation. Trial registration: ChiCTR-OCH-14004674.

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Cite

BibTeXRIS
BibTeX
@article{lin2026ushaped,
  title = {{U-shaped association of non-HDL-C/HDL-C ratio with atrial fibrillation recurrence postcatheter ablation: a cohort study}},
  author = {Mingjie Lin and Naiyan Qiu and Nan Yang and Tongshuai Chen and Bing Rong and Wenqiang Han and Maduray Kellina and Jingquan Zhong and Kai Zhang},
  journal = {European Journal of Medical Research},
  year = {2026},
  month = jul,
  doi = {10.1186/s40001-026-04942-4},
  url = {https://doi.org/10.1186/s40001-026-04942-4},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - U-shaped association of non-HDL-C/HDL-C ratio with atrial fibrillation recurrence postcatheter ablation: a cohort study
AU  - Mingjie Lin
AU  - Naiyan Qiu
AU  - Nan Yang
AU  - Tongshuai Chen
AU  - Bing Rong
AU  - Wenqiang Han
AU  - Maduray Kellina
AU  - Jingquan Zhong
AU  - Kai Zhang
PY  - 2026
DA  - 2026/07/01
JO  - European Journal of Medical Research
DO  - 10.1186/s40001-026-04942-4
UR  - https://doi.org/10.1186/s40001-026-04942-4
AB  - Background The prognostic value of lipid metrics in atrial fibrillation (AF) recurrence following catheter ablation (CA) remains controversial. This study investigated the prognostic value of the non-high-density lipoprotein-cholesterol/high-density lipoprotein-cholesterol ratio (NHHR) in predicting postablation AF recurrence. Methods In this cohort study, 1,728 patients with AF undergoing first-time CA at our center (2017–2020) were stratified by NHHR quartiles (Q1–Q4). The primary endpoint was AF recurrence and the secondary endpoint was incidence of Major Adverse Cardiovascular and Cerebrovascular Events (MACCEs) following CA. Results A U-shaped association was observed between the NHHR and AF recurrence (Pnonlinear = 0.021), with an inflection point at NHHR = 2.61, driven predominantly by an increased recurrence risk at lower NHHR values. Compared to the third quartile (Q3) (2.62–3.26), patients in the first NHHR quartile (Q1) had a 63.6% higher risk of recurrence (hazard ratio [HR] = 1.636, 95% confidence interval [CI]: 1.235–2.166). For NHHR < 2.61, the risk of recurrence risk decreased with an adjusted HR of 0.715 (95% CI, 0.524–0.977, P = 0.035) for every one-unit increment in the NHHR. The association for NHHR values above the inflection point was not statistically significant. Subgroup analyses confirmed consistency across age, sex, AF subtypes and duration, diabetes mellitus, CHA2DS2-VA scores, left atrial diameter, and non-PVI lesions (Pinteraction > 0.05). Sensitivity analysis further validated the temporal robustness of the association. NHHR demonstrated no association with MACCEs, underscoring its AF-specific prognostic value. Conclusions NHHR exhibited a U-shaped association with postablation AF recurrence, driven primarily by an increased risk at lower values. It may serve as a nonlinear lipid biomarker, with its role at the higher values requiring further investigation. Integration into clinical risk stratification is warranted, although therapeutic targeting requires additional mechanistic validation. Trial registration: ChiCTR-OCH-14004674.
SN  - 2047-783X
ER  -