Endothelial activation and stress index and cardiovascular disease among American population-findings from NHANES 1999-2018.

backgroundEndothelial Activation and Stress Index (EASIX), derived from measurements of platelet count, creatinine, and lactate dehydrogenase, can serve as an indicator for systemic inflammation and endothelial dysfunction. However, the association between EASIX and the prevalence of cardiovascular disease (CVD) in the general American adults has yet to be explored. This study aims to explore this potential association.

methodsIn this cross-sectional study, participants from NHANES 1999-2018 were analyzed. To examine the association, multivariable logistic regression analyses and restricted cubic spline methods were conducted, supplemented by subgroup and interaction analyses. Statistical analyses were performed with R software (Version 4.1.3).

resultsThis study comprised 38,794 subjects, with a prevalence of CVD at 10.4%. The median age was 49 years (range, 34-64), and 19866 (51.2%) were female. After adjusting for all covariates, elevated EASIX levels were associated with an increased prevalence of CVD [adjusted odds ratios (aOR) = 1.33, 95% CI: 1.26, 1.41], myocardial infarction (aOR = 1.16, 95% CI: 1.10, 1.23), angina pectoris (aOR = 1.15, 95% CI: 1.07, 1.23), congestive heart failure (aOR = 1.29, 95% CI: 1.22, 1.37), coronary heart disease (aOR = 1.23, 95% CI: 1.16, 1.31), and stroke (aOR = 1.16, 95% CI: 1.09, 1.23). A notable J-shaped association was observed, with a significant inflection point at 82.5, which was more pronounced in older subjects and those with hyperlipidemia. Furthermore, EASIX demonstrates the superior predictive capability for CVD, compared to other individual indices (AUC = 0.700, 95% CI: 0.691, 0.709).

conclusionAn elevated EASIX is associated with a greater prevalence of CVD in American adults. EASIX exhibited better performance in evaluating the associations compared to other individual indices. It is expected that EASIX can become a more effective metric for identifying populations at an early risk of CVD.