ASSOCIATION BETWEEN NEUTROPHIL PERCENTAGE-TO-ALBUMIN RATIO AND RISK OF STROKE IN PATIENTS WITH HYPERTENSION: A COHORT STUDY

Objective: Stroke accounts for a great proportion of the global burden of disease and neutrophil percentage-to-albumin ratio (NPAR) has been reported as a critical predictor on the risks and clinical outcomes of cardiovascular diseases (CVDs). This study investigated the predictive value of NPAR on the risk of stroke in individuals with hypertension.Design and method: This cohort study utilized data from the China Stroke Primary Prevention Trial (CSPPT). Data was collected from May 19, 2008, and followed up till August 24, 2013. The NPAR was calculated using the formula: Neutrophil percentage (%) ∗ 100 / Albumin (g/dl). Multivariate analysis using Cox proportional hazards models was conducted. Further interactions between NPAR and risk of stroke were examined using subgroup analysis. Results: A total of 13,848 individuals with a mean (SD) age of 59.8 (7.6) years and 40.2% male were included. During a median follow-up period of 4.5 years, 371 subjects (9.7%) experienced a stroke event. The time-to-event analysis demonstrated that participants in the lowest quartile (Q1) had a significantly higher long-term survival probability compared to those in quartiles Q2–Q4. Cox regression analyses revealed that in the total population, compared to participants in Q1 (NPAR < 10.7), those in quartiles Q2, Q3, and Q4 demonstrated a significantly higher risk of stroke in both crude and adjusted model (In adjusted model, Q2: HR = 1.76, 95% CI: 1.31-2.36, p < 0.001; Q3: HR = 1.54, 95% CI: 1.14-2.08, p = 0.005; Q4: HR = 1.57, 95% CI: 1.17-2.12, p = 0.003). The result remained consistent when participants in quartiles Q2–Q4 were combined and compared to those in Q1. In subgroup analyses, the association between NPAR and stroke incidence was notably stronger in females (HR: 2.13 vs 1.16 for female and male, p for interaction=0.035). Conclusions: Higher NPAR levels were significantly associated with increased risk of stroke, and the associations were particularly pronounced in female subjects.