Non-High-Density to High Density Lipoprotein Cholesterol Ratio Linked with Psoriasis

There is a significant positive association between the non-high-density lipoprotein to high-density lipoprotein cholesterol ratio (NHHR) and psoriasis, according to recent findings.1

These data would suggest that NHHR is a potentially useful risk indicator for psoriasis within clinical settings. Ligun Li, of The First Affiliated Hospital of Wenzhou Medical University’s Department of Plastic Surgery in China, was a corresponding author of these data.

Li and colleagues highlighted that in emerging research, NHHR has been linked with such conditions as metabolic syndrome, chronic kidney disease, and nonalcoholic fatty liver disease (NAFLD).2 Such conclusions could suggest that NHHR may have stronger predictive value than traditional lipid indices, and Li et al noted both the inflammatory and metabolic overlap between psoriasis and cardiometabolic conditions.

“This observational analysis was supplemented by a two-sample Mendelian randomisation (MR) approach leveraging multi-ancestry GWAS summary statistics to indirectly assess the potential causal relationship between NHHR and psoriasis,” Li and coauthors wrote.1

Study Design and Notable Findings

The investigative team highlighted that the ratio of NHHR has lately emerged as a practical and inclusive indicator of atherogenic dyslipidemia. They added that this reflects the connection between lipoproteins that promote versus protect against atherosclerosis.

In this investigation, the team drew baseline participant characteristics from the 2003–2006 and 2009–2014 National Health and Nutrition Examination Survey (NHANES) datasets. These data would form their primary analytic sample. Li and colleagues also looked at an additional subset from the 2003–2006 and 2011–2014 cycles, using them specifically for analyses incorporating psoriasis severity.

Within their analysis's main cohort (2003–2006 and 2009–2014), the investigators included 15,437 individuals. Among these patients, 3.0% were shown to have a history of psoriasis. These subjects were 52% male and their average (SD) age was noted as 44.73 (15.57) years. The mean (SD) NHHR among these individuals was 3.00 (1.39), and tertiles were defined as < 2.219, 2.220–3.318, and > 3.320.

The team stratified their subgroup analyses by sex, age, and patient income, while severity-stratified analyses utilized the subsample with psoriasis severity information (2003–2006 and 2011–2014). Li and coauthors highlighted that, more commonly, the participants in higher NHHR tertiles were male. Those in highler NHHR tertiles were also noted as having a greater prevalence of psoriasis. Additionally, higher NHHR tertiles tended to have lower family poverty-income ratios and lower educational attainment.

In the investigative team's multivariable logistic regression models, they applied adjustment for medication utilization, cardiovascular disease, glucocorticoid therapy, and other covariates to the 15,437 adults in the study. Additional models compared NHHR against conventional lipid parameters including HDL-C, total cholesterol (TC), and non-HDL-C. The investigators conducted all of their analyses through R (version 4.4), and they considered all P values less than .05 to be statistically significant.

Mendelian randomisation (MR) analyses were further performed via GWAS summary statistics from East Asian, European, African, and Middle Eastern populations, and meta-analysis were applied by Li et al to enhance their study's precision. Overall, their findings suggest that NHHR was significantly linked with developing psoriasis (OR = 1.08, 95% CI: 1.00–1.17; P = .039). Subjects in the top NHHR quartile had a 48% higher risk of psoriasis as opposed to those with those in the lowest quartile (OR = 1.48, 95% CI: 1.09–2.00).

“Although genetic evidence did not support causality, the observational findings highlight NHHR as a potentially useful risk indicator in clinical settings,” the investigative team concluded.1 “Further prospective and mechanistic studies are needed to clarify its role in psoriasis pathophysiology.”

References

1. H Dai, Z Li, J Hu, et al. The Association Between Non-High-Density Lipoprotein Cholesterol to High-Density Lipoprotein Cholesterol Ratio With Psoriasis: A Cross-Sectional Survey and Genetic Approach. Experimental Dermatology 34, no. 9 (2025): e70165, https://doi.org/10.1111/exd.70165. Accessed September 8, 2025.

2. Zuo PY, Chen XL, Liu CY, et al. Non-HDL-cholesterol to HDL-cholesterol ratio as an independent risk factor for the development of chronic kidney disease. Nutr Metab Cardiovasc Dis. 2015 Jun;25(6):582-7. doi: 10.1016/j.numecd.2015.03.003. Epub 2015 Mar 13. PMID: 25921842. Accessed September 8, 2025.