The Association of Monocytes/High-Density Lipoprotein Cholesterol Ratio With Cardiovascular-Kidney-Metabolic Syndrome and Its All-Cause Mortality - Evidence From NHANES 2003-2018.

BackgroundCardiovascular-kidney-metabolic syndrome, defined by the American Heart Association (AHA), is characterized by heart and kidney dysfunction. This dysfunction results from systemic inflammation and oxidative stress, which are caused by insulin resistance (IR) and severe obesity. This study explores the association between the monocyte/high-density lipoprotein-cholesterol ratio (MHR) and cardiovascular-kidney-metabolic syndrome, and its association with all-cause mortality.MethodsThe data for this study come from the National Health and Nutrition Examination Survey (NHANES) conducted from 2003 to 2018 and the National Death Index (NDI) database. Statistical analysis methods such as multiple logistic regression and Cox regression were employed. Additionally, restrictive cubic spline models and subgroup analyses were applied.ResultsThis study included 13,323 participants, of whom 2,452 were identified as having Cardiovascular-Kidney-Metabolic (CKM) syndrome. MHR levels differed significantly between participants with and without CKM syndrome. Weighted logistic regression showed that higher MHR was significantly associated with increased prevalence of CKM syndrome (OR: 1.19; 95% CI: 1.07-1.32). When MHR was analyzed by quartiles, the prevalence of CKM syndrome increased progressively across quartiles (Q4 vs. Q1, OR: 1.63; 95% CI: 1.27-2.11). Restricted cubic spline analysis revealed a nonlinear positive association between MHR and CKM syndrome (P-nonlinear < 0.001). Among participants with CKM syndrome, weighted Cox regression showed that MHR was significantly associated with all-cause mortality (HR: 1.04; 95% CI: 1.01-1.06). After covariate adjustment, restricted cubic spline analysis demonstrated a significant overall association between MHR and mortality (global P = 0.02), with no evidence of nonlinearity (P for nonlinearity = 0.48), suggesting a linear dose-response relationship. Subgroup analyses indicated that the association between MHR and all-cause mortality in CKM syndrome was generally consistent across subgroups, with no significant interactions detected.ConclusionOur study demonstrates that MHR is independently associated with a higher prevalence of CKM syndrome. Among patients with CKM syndrome, MHR showed a modest association with all-cause mortality. These findings suggest that MHR may have potential utility as a biomarker for CKM syndrome, although its prognostic value for mortality appears limited and warrants further prospective validation.