Vitamin D as a Key Mediator Between C-reactive Protein to Albumin Ratio and Congestive Heart Failure in an Elderly Population: An Innovative Exploration Using the NHANES Database
Background: The C-reactive protein-to-albumin ratio (CAR), a marker of inflammation and nutritional status (calculated as C-reactive protein [CRP]/albumin [ALB]), is associated with increased mortality in congestive heart failure (CHF). However, whether vitamin D modulates the CAR...
Saved in:
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
IMR Press
2025-07-01
|
| Series: | Reviews in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.imrpress.com/journal/RCM/26/7/10.31083/RCM37740 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849394495190204416 |
|---|---|
| author | Yufeng Wei Zhaofeng Zhang |
| author_facet | Yufeng Wei Zhaofeng Zhang |
| author_sort | Yufeng Wei |
| collection | DOAJ |
| description | Background: The C-reactive protein-to-albumin ratio (CAR), a marker of inflammation and nutritional status (calculated as C-reactive protein [CRP]/albumin [ALB]), is associated with increased mortality in congestive heart failure (CHF). However, whether vitamin D modulates the CAR-CHF relationship remains unclear. Using data from the National Health and Nutrition Examination Survey (NHANES), this study aimed to investigate the mediating role of vitamin D in the association between CAR and CHF among older adults, with implications for cardiovascular disease prevention. Methods: Data from NHANES 2001–2010 were analyzed, including adults aged ≥65 years. Multivariate logistic regression was used to assess the independent association of CAR and 25-hydroxyvitamin D [25(OH)D] with CHF. Pearson correlation evaluated bivariate relationships between continuous variables (vitamin D, CAR), while Spearman correlation assessed associations between the dichotomous CHF status and continuous variables (vitamin D, CAR). Mediation analysis (Hayes’ PROCESS Model 4, 5000 bootstrap samples) tested whether 25(OH)D mediated the CAR-CHF link. Subgroup analyses explored effect modification by age, sex, and comorbidities. Results: A total of 4128 participants (mean age: 70.0 years; 55.81% male) were included, with 247 (5.98%) diagnosed with CHF. Vitamin D deficiency (25(OH)D <20 ng/mL) and insufficiency (20–30 ng/mL) were prevalent (71.2%). Key findings included: Bivariate associations: Lower 25(OH)D correlated with higher CAR (r = –0.12, p = 0.004) and increased CHF risk (Spearman ρ = –0.061, p < 0.01), while CAR was positively correlated with CHF (Spearman ρ = 0.080, p < 0.01). Multivariate analysis: CAR was an independent risk factor for CHF (adjusted OR for highest vs. lowest quartile: 1.96, 95% confidence interval (CI): 1.31–2.95, p < 0.001; p-trend < 0.001. Vitamin D sufficiency (25(OH)D ≥30 ng/mL) was associated with a lower CHF risk compared to deficiency (25(OH)D <20 ng/mL, OR: 0.56, 95% CI: 0.38–0.83, p = 0.003), indicating that deficiency was indirectly linked to higher risk. Mediation effect: 25(OH)D partially mediated the CAR-CHF association, explaining 3.00% of the total effect (indirect effect: 0.002, 95% CI: 0.001–0.005, p = 0.039). Predictive value: CAR had modest accuracy for CHF (area under the curve (AUC) = 0.597, 95% CI: 0.560–0.634), with an optimal cut-off of 0.149 (sensitivity: 59.1%, specificity: 56.4%). Conclusion: Elevated CAR and vitamin D deficiency are independently associated with increased CHF risk in older adults. Vitamin D partially mediated the association between CAR and CHF, underscoring its role in linking inflammation/nutrition status to cardiovascular risk. Clinicians should monitor both biomarkers in CHF prevention, prioritizing inflammation control and vitamin D repletion in high-risk populations. |
| format | Article |
| id | doaj-art-e2e554ba078641adba66c5373ec75af7 |
| institution | Kabale University |
| issn | 1530-6550 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | IMR Press |
| record_format | Article |
| series | Reviews in Cardiovascular Medicine |
| spelling | doaj-art-e2e554ba078641adba66c5373ec75af72025-08-20T03:39:57ZengIMR PressReviews in Cardiovascular Medicine1530-65502025-07-012673774010.31083/RCM37740S1530-6550(25)01834-4Vitamin D as a Key Mediator Between C-reactive Protein to Albumin Ratio and Congestive Heart Failure in an Elderly Population: An Innovative Exploration Using the NHANES DatabaseYufeng Wei0Zhaofeng Zhang1Department of Pharmacy, Ganzhou People’s Hospital, 341000 Ganzhou, Jiangxi, ChinaDepartment of Pharmacology, Ganzhou Dermatosis Hospital, 341000 Ganzhou, Jiangxi, ChinaBackground: The C-reactive protein-to-albumin ratio (CAR), a marker of inflammation and nutritional status (calculated as C-reactive protein [CRP]/albumin [ALB]), is associated with increased mortality in congestive heart failure (CHF). However, whether vitamin D modulates the CAR-CHF relationship remains unclear. Using data from the National Health and Nutrition Examination Survey (NHANES), this study aimed to investigate the mediating role of vitamin D in the association between CAR and CHF among older adults, with implications for cardiovascular disease prevention. Methods: Data from NHANES 2001–2010 were analyzed, including adults aged ≥65 years. Multivariate logistic regression was used to assess the independent association of CAR and 25-hydroxyvitamin D [25(OH)D] with CHF. Pearson correlation evaluated bivariate relationships between continuous variables (vitamin D, CAR), while Spearman correlation assessed associations between the dichotomous CHF status and continuous variables (vitamin D, CAR). Mediation analysis (Hayes’ PROCESS Model 4, 5000 bootstrap samples) tested whether 25(OH)D mediated the CAR-CHF link. Subgroup analyses explored effect modification by age, sex, and comorbidities. Results: A total of 4128 participants (mean age: 70.0 years; 55.81% male) were included, with 247 (5.98%) diagnosed with CHF. Vitamin D deficiency (25(OH)D <20 ng/mL) and insufficiency (20–30 ng/mL) were prevalent (71.2%). Key findings included: Bivariate associations: Lower 25(OH)D correlated with higher CAR (r = –0.12, p = 0.004) and increased CHF risk (Spearman ρ = –0.061, p < 0.01), while CAR was positively correlated with CHF (Spearman ρ = 0.080, p < 0.01). Multivariate analysis: CAR was an independent risk factor for CHF (adjusted OR for highest vs. lowest quartile: 1.96, 95% confidence interval (CI): 1.31–2.95, p < 0.001; p-trend < 0.001. Vitamin D sufficiency (25(OH)D ≥30 ng/mL) was associated with a lower CHF risk compared to deficiency (25(OH)D <20 ng/mL, OR: 0.56, 95% CI: 0.38–0.83, p = 0.003), indicating that deficiency was indirectly linked to higher risk. Mediation effect: 25(OH)D partially mediated the CAR-CHF association, explaining 3.00% of the total effect (indirect effect: 0.002, 95% CI: 0.001–0.005, p = 0.039). Predictive value: CAR had modest accuracy for CHF (area under the curve (AUC) = 0.597, 95% CI: 0.560–0.634), with an optimal cut-off of 0.149 (sensitivity: 59.1%, specificity: 56.4%). Conclusion: Elevated CAR and vitamin D deficiency are independently associated with increased CHF risk in older adults. Vitamin D partially mediated the association between CAR and CHF, underscoring its role in linking inflammation/nutrition status to cardiovascular risk. Clinicians should monitor both biomarkers in CHF prevention, prioritizing inflammation control and vitamin D repletion in high-risk populations.https://www.imrpress.com/journal/RCM/26/7/10.31083/RCM37740vitamin dc-reactive protein to albumin ratio (car)congestive heart failure (chf)mediation effect analysisnational health and nutrition examination survey (nhanes)cross-sectional study |
| spellingShingle | Yufeng Wei Zhaofeng Zhang Vitamin D as a Key Mediator Between C-reactive Protein to Albumin Ratio and Congestive Heart Failure in an Elderly Population: An Innovative Exploration Using the NHANES Database Reviews in Cardiovascular Medicine vitamin d c-reactive protein to albumin ratio (car) congestive heart failure (chf) mediation effect analysis national health and nutrition examination survey (nhanes) cross-sectional study |
| title | Vitamin D as a Key Mediator Between C-reactive Protein to Albumin Ratio and Congestive Heart Failure in an Elderly Population: An Innovative Exploration Using the NHANES Database |
| title_full | Vitamin D as a Key Mediator Between C-reactive Protein to Albumin Ratio and Congestive Heart Failure in an Elderly Population: An Innovative Exploration Using the NHANES Database |
| title_fullStr | Vitamin D as a Key Mediator Between C-reactive Protein to Albumin Ratio and Congestive Heart Failure in an Elderly Population: An Innovative Exploration Using the NHANES Database |
| title_full_unstemmed | Vitamin D as a Key Mediator Between C-reactive Protein to Albumin Ratio and Congestive Heart Failure in an Elderly Population: An Innovative Exploration Using the NHANES Database |
| title_short | Vitamin D as a Key Mediator Between C-reactive Protein to Albumin Ratio and Congestive Heart Failure in an Elderly Population: An Innovative Exploration Using the NHANES Database |
| title_sort | vitamin d as a key mediator between c reactive protein to albumin ratio and congestive heart failure in an elderly population an innovative exploration using the nhanes database |
| topic | vitamin d c-reactive protein to albumin ratio (car) congestive heart failure (chf) mediation effect analysis national health and nutrition examination survey (nhanes) cross-sectional study |
| url | https://www.imrpress.com/journal/RCM/26/7/10.31083/RCM37740 |
| work_keys_str_mv | AT yufengwei vitamindasakeymediatorbetweencreactiveproteintoalbuminratioandcongestiveheartfailureinanelderlypopulationaninnovativeexplorationusingthenhanesdatabase AT zhaofengzhang vitamindasakeymediatorbetweencreactiveproteintoalbuminratioandcongestiveheartfailureinanelderlypopulationaninnovativeexplorationusingthenhanesdatabase |