Nonlinear association between red cell distribution width/albumin ratio and peripheral arterial disease in the NHANES: a cross-section study with propensity score matching analysis.

Abstract

Background: Peripheral arterial disease (PAD) is a prevalent cardiovascular condition that affects up to 200 million people globally, and has significant implications for morbidity and mortality. Recent studies have identified the red cell distribution width-to-albumin ratio (RDW/ALB) as a potential systemic inflammatory marker that is correlated with several cardiovascular and inflammatory diseases including PAD. However, the comprehensive role of RDW/ALB in PAD remains underexplored. The objective of this study was to elucidate the relationship between RDW/ALB and PAD and to provide novel insights into the prevention and treatment of PAD.

Methods: This retrospective cross-sectional study leveraged data from the NHANES data (1999-2004) identifying PAD using ankle-brachial index measurements (<0.90). The association with PAD was assessed using multivariable logistic regression, complemented by a restricted cubic spline for nonlinearity, and propensity score methods for robustness checks, including propensity score matching and subgroup analyses.

Results: This study included 6,421 participants, 452 of whom had PAD. The mean age was 70.1 years; the patients were predominantly male. After adjustment, the RDW/ALB ratio showed a significant association with PAD (OR 1.71, 95% CI 1.29-2.26, p < 0.001). After quartiles of RDW/ALB, the risk of PAD was determined to be 2.03 (95% CI 1.31-3.14) in the Q4 group compared with the Q1 group in the adjusted complete model. The restricted sample cubic spline of RDW/ALB and risk of developing PAD demonstrated a nonlinear relationship. The risk of PAD increased considerably with higher RDW/ALB ratios less than 4.08. Subgroup and PSM analyses underscored the consistency of these findings.

Conclusions: The study demonstrated a significant association between RDW/ALB and PAD, with a nonlinear relationship and a threshold effect. Further prospective clinical research is required to validate the relationship between the RDW/ALB ratio and PAD.