ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiovascular Epidemiology and Prevention
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1645793
Association of the monocyte-to-albumin ratio with cardiovascular disease and with all-cause and cardiovascular mortality in the general population
Provisionally accepted
- 1Guizhou University of Traditional Chinese Medicine, Guiyang, China
- 2Zunyi Medical University, Zunyi, China
- 3贵州医科大学, 贵州医科大学 贵阳, China
- 4Department of Nursing, Guizhou Provincial People's Hospital, Guizhou Guiyang, China
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Objective: This investigation examined the links of monocyte-to-albumin ratio (MAR) with cardiovascular disease (CVD), alongside all-cause and CVD mortality in the general population, employing records from the National Health and Nutrition Examination Survey (NHANES) conducted between 2001 and 2018, connected to the National Death Index (NDI). Methods: Participants were split into three cohorts based on MAR. The link between MAR and CVD was examined by multivariable logistic regression analysis. Curve-fitting techniques investigated potential nonlinear associations. Receiver operating characteristic (ROC) curves determined the predictive capability of MAR regarding CVD. The links of MAR with all-cause and CVD mortality were investigated utilizing Cox regression modeling. Restricted cubic splines (RCS) curves illustrated the dose-dependent relationships. The weighted Kaplan-Meier method assessed survival distinctions among MAR tertile categories. Sensitivity and stratified analyses were performed to assess the robustness and stability of the results. Further, NRI analysis was conducted to quantify the predictive performance of MAR. Results: Multivariable logistic regression identified a notable positive link between MAR and CVD (p < 0.05), with a nonlinear trend confirmed by smoothing curves (nonlinear p = 0.019). Subgroup analyses indicated the consistency of this association (interaction p > 0.05). Through ROC evaluation, MAR exhibited robust predictive capability for CVD. Increased MAR measurements correlated with heightened risk of all-cause mortality (hazard ratio [HR]: 1.25, 95% CI: 1.08–1.44) and CVD mortality (HR: 1.46, 95% CI: 1.10–1.93). RCS evaluation determined a nonlinear connection between MAR and all-cause mortality (nonlinear p < 0.05). The results maintained stability throughout sensitivity and stratified assessments. Conclusions: MAR demonstrated a positive correlation with CVD, and higher MAR levels were notably connected to an occurrence rate of both all-cause and CVD mortality. Further exploration of the feasibility and predictive capabilities of MAR as an emerging inflammatory marker is warranted.
Keywords: Monocyte-to-albumin ratio, cardiovascular disease, All-cause mortality, Cardiovascular mortality, NHANES
Received: 23 Jun 2025; Accepted: 03 Sep 2025.
Copyright: © 2025 Jin, Xiaoyue, Chen, Li, WU, Tian and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Juan Li, Department of Nursing, Guizhou Provincial People's Hospital, Guizhou Guiyang, China
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