Mediating role of neutrophil-percentage-to-albumin ratio in the association between stroke and heart failure among U.S. adults

BACKGROUND: Stroke is an independent risk factor for heart failure (HF), and they are both linked to systemic inflammation. The neutrophil-percentage-to-albumin ratio (NPAR) is a novel inflammation biomarker. However, it is unclear whether the NPAR mediates the relationship between stroke and HF. METHODS: We analyzed data from 42,101 adults in the NHANES. Multivariable regression models adjusted for confounders were used to assess associations of stroke with NPAR and HF. Restricted cubic spline (RCS) curves were employed to investigate potential non-linear or linear relationships between NPAR and HF. Furthermore, mediation analysis was performed to assess the potential mediating role of NPAR. RESULTS: NPAR levels of participants with HF and/or stroke were higher than those without HF and stroke (P < 0.0001). Following full adjustment, stroke was positively associated with NPAR (β = 0.421, 95 % CI = 0.242, 0.600, P < 0.0001), with stronger associations noted in females (interaction β = 0.450, interaction p-value < 0.001). Similarly, stroke was positively associated with HF (OR = 3.0301, 95 % CI = 2.4143, 3.8030, P < 0.0001). RCS analysis further revealed a nonlinear correlation between NPAR and HF. Furthermore, mediation analysis revealed that NPAR significantly mediated the relationship between stroke and HF (proportion mediated = 3.58 %, P < 0.0001). CONCLUSION: This study identified that stroke and NPAR are significantly related to HF, which increases the risk of HF in the adults, and the mediating role of NPAR is significant in the relationship between stroke and HF. This finding highlights the necessity of regulating the inflammatory-nutritional.