Associations Between Ratio of Red Blood Cell Distribution Width to Albumin With Cardiovascular Mortality and Specific Cardiovascular Disease

The ratio of red cell distribution width (RDW) to albumin (RAR) has been shown to correlate with poor prognosis in patients with various diseases. However, the relationship between RAR and cardiovascular disease (CVD) remains inadequately elucidated. We conducted this study using data from 12 755 participants in the National Health and Nutrition Examination Survey (NHANES) 2007 to 2018. Multivariable regression analysis and subgroup analysis were conducted to analyze the potential relationship. In this study, RAR was significantly and positively associated with CVD mortality (hazard ratio [HR] = 1.99, 95% CI = 1.81-2.19, <i>P</i> < .001), total CVD (odds ratios [OR] = 1.42, 95% CI = 1.31-1.54, <i>P</i> < .001), congestive heart failure (CHF; OR = 1.70, 95% CI = 1.52-1.90, <i>P</i> < .001), coronary heart disease (CHD; OR = 1.18, 95% CI = 1.05-1.33 <i>P</i> = .006), and myocardial infarction (MI; OR = 1.32, 95% CI = 1.18-1.47, <i>P</i> < .001). Subgroup analyses confirmed the robustness of the findings. Our findings demonstrate significant and independent associations of RAR levels with CVD mortality and specific CVD. As a straightforward, cost-effective, and readily accessible metric, RAR has the potential to offer novel insights into CVD risk assessment.