Association between novel hematological inflammatory indices and prevalent peripheral arterial disease: A cross-sectional analysis from the national health and nutrition examination survey

ObjectivePeripheral arterial disease (PAD) is a prevalent cardiovascular disorder that significantly impairs functional capacity and quality of life. Vascular inflammation is recognized as a key pathophysiological component of PAD. This cross-sectional study aimed to investigate the associations between a panel of novel, readily available hematological inflammatory indices and the presence of PAD in a nationally representative sample.MethodsThis is a cross-sectional study. This investigation utilized data from the National Health and Nutrition Examination Survey (NHANES) 1999 to 2004 cycles. PAD diagnosis was rigorously defined according to American Heart Association guidelines, with ankle-brachial index (ABI) values ≤0.9 obtained through standardized bilateral lower extremity doppler measurements and repeated verification protocols. Our analytical approach incorporated advanced statistical methodologies to elucidate complex relationships: Survey-weighted multivariable logistic regression analyses were conducted with sequential adjustment for demographic characteristics, clinical covariates, and traditional cardiovascular risk factors. The inflammatory biomarker panel included both composite indices - Systemic Inflammation Response Index (SIRI), Aggregate Index of Systemic Inflammation (AISI), Systemic Immune-Inflammation Index (SII), Neutrophil-to-HDL ratio (NHR), Monocyte-to-HDL ratio (MHR), Lymphocyte-to-HDL ratio (LHR), Platelet-to-HDL ratio (PHR) and Neutrophil-to-Lymphocyte ratio (NLR).ResultsAmong 5,954 eligible participants, higher levels of SIRI, MHR, and NHR were significantly associated with an increased odds of prevalent PAD in fully adjusted models. Threshold analysis revealed nonlinear associations for MHR with PAD, with positive associations observed below identified inflection points. In comparative receiver operating characteristic (ROC) curve analysis, SIRI demonstrated modest discriminatory ability for PAD presence, though its predictive utility, like that of the other indices, was limited.ConclusionIn this large, population-based cross-sectional study, several novel hematological inflammatory indices, particularly SIRI, MHR, and NHR, showed significant associations with prevalent PAD. These findings contribute to the understanding of the inflammatory landscape in PAD. However, their utility for clinical discrimination in a cross-sectional setting appears constrained, highlighting the need for further investigation into their potential roles.