Association between hemoglobin, albumin, lymphocyte, and platelet scores and all-cause and cardiovascular mortality among adults with atherosclerotic cardiovascular disease in the United States: An analysis of NHANES

Atherosclerotic cardiovascular disease (ASCVD) remains the foremost cause of mortality in the United States. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score, a straightforward and economical indicator, combines inflammatory and nutritional status. However, its association with ASCVD incidence and long-term mortality is uncertain. We conducted a cross-sectional study using US National Health and Nutrition Examination Survey data from 1999 to 2020, with mortality data collected until December 31, 2019, via the National Death Index. Weighted multivariable logistic regression was employed to assess the association between HALP scores and ASCVD prevalence. Kaplan-Meier analyses and weighted multivariate-adjusted Cox analyses were utilized to examine the relationship between HALP scores and all-cause and cardiovascular disease (CVD) mortality among patients with ASCVD. Restricted cubic spline curve (RCS) analysis was used to identify nonlinear relationships, and multisubgroup and sensitivity analyses were conducted to ensure the robustness of the results. This cohort study comprised 41,147 participants, including 4047 with ASCVD (prevalence: 7.7%). Over a median follow-up of 85 (49, 131) months, 1726 deaths occurred among patients with ASCVD, with 575 attributed to CVD. Multivariable-adjusted modeling showed no association between HALP score and ASCVD incidence. However, multivariable-adjusted Cox regression and RCS analyses revealed a nonlinear relationship between HALP scores and all-cause mortality and CVD mortality in patients with ASCVD (all P for nonlinearity < 0.001). Higher HALP scores were significantly associated with reduced all-cause and CVD mortality in patients with ASCVD (all P for trend < 0.05). Our results indicate a significant nonlinear association between HALP scores and all-cause as well as cardiovascular mortality in patients with ASCVD. Higher HALP scores are linked to decreased all-cause mortality and CVD mortality.