A-001 Structural Relationship Between Non–HDL Cholesterol and the Total Cholesterol/HDL Ratio Across Sexes: Implications for Cardiovascular Risk Stratification in Chile

Abstract

Cardiovascular disease (CVD) remains the leading cause of mortality in Chile, a middle-income country characterized by high prevalence of obesity, insulin resistance, and hypertriglyceridemia. In this metabolic context, non–high-density lipoprotein cholesterol (non-HDL-C) and the total cholesterol/HDL cholesterol (TC/HDL) ratio have been proposed as robust, cost-effective indicators of atherogenic burden. We evaluated their metabolic coherence and sex-specific behavior in a large Chilean cohort. A cross-sectional analysis was conducted using a database of 60,180 adults (59.5% women) from three healthcare providers. Linear regression models were used to assess the relationship between non-HDL-C and the TC/HDL ratio, stratified by sex. Interaction models (sex × TC/HDL) adjusted for age were fitted to formally compare slopes between men and women. Additional age-adjusted models evaluated sex differences in total cholesterol and triglycerides. Results are reported as regression coefficients with 95% confidence intervals (95% CI). Non-HDL-C demonstrated a strong linear association with the TC/HDL ratio in both sexes, with high coefficients of determination. In age-adjusted interaction models, the sex × TC/HDL term was not statistically significant, indicating parallel slopes and a consistent relationship across sexes. Age-adjusted analyses showed that men had lower total cholesterol (ß ˜ -7 mg/dL; p < 0.001) and higher triglycerides (ß ˜ +15–18 mg/dL; p < 0.001) compared with women. Despite these lipid phenotype differences, the structural association between non-HDL-C and the TC/HDL ratio remained robust and sex-independent. In this large Chilean cohort, non-HDL-C and the TC/HDL ratio demonstrated strong biological coherence and consistent behavior across sexes. Given their metabolic relevance, analytical simplicity, and cost neutrality, these parameters represent practical and scientifically sound tools for cardiovascular risk stratification in middle-income countries with high cardiometabolic burden.