Objective：To explore the association of LDL-C to HDL-C ratio（LHR） with metabolic syndrome（MetS） and cardiovascu－lar outcomes in patients with non-ST segment elevation myocardial infarction（NSTEMI）. Methods：A retrospective cohort study was conducted，involving 408 patients diagnosed with NSTEMI（male accounted for 67.4%） who were admitted to the cardiology department in our hospital from January 2019 to July 2019. According to the median LHR，the subjects were divided into the low LHR group（≤2.72，204 cases） and the high LHR group（>2.72，204 cases）. Clinical data and laboratory parameters were compared between the two groups；the correlation between LHR levels and MetS was analyzed；the association of LHR with major adverse cardiovascular events（MACE） was evaluated during 12 months follow-up after admission. Results：The high LHR group had a higher incidence of MetS and MACE than that of the low LHR group in patients with NSTEMI（P<0.05）. Multivariate logistic regression analysis showed that LHR was significantly correlated with MetS（OR=1.424，95%CI=1.031-1.965，P=0.032） and high LHR level might be an independent risk factor for MetS. After 12 months of follow-up，totally 69 cases developed MACE（16.9%） including 48 cases in the high LHR group and 21 cases in the low LHR group. Multivariate COX regression analysis further indicated that LHR level was significantly associated with increased MACE risk（HR=1.309，95%CI=1.021-1.678，P=0.034）. High LHR might be an independent predictor of MACE（HR=2.271，95%CI=1.345-3.836，P=0.002）. Conclusion：LHR may be an independent risk factor for MetS and MACE and calculating LHR contributes to controlling cardiovascular risk in patients with NSTEMI.