Association of Naples Prognostic Score with cardiovascular disease risk and its longitudinal prognostic impact on mortality in cardiovascular disease patients: Evidence from NHANES

Background and aim: The Naples Prognostic Score (NPS) predicts outcomes in various diseases, but its impact on cardiovascular disease (CVD) is understudied. This study investigates the association between NPS and CVD prevalence and mortality among US adults. Methods and results: This study utilized data from the Continuous National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2016, with mortality follow-up data available through December 31, 2019. NPS was calculated using serum albumin, total cholesterol, neutrophil to lymphocyte ratio, and lymphocyte to monocyte ratio. Participants were stratified into low, moderate, and high NPS groups. Multiple logistic regression estimated odds ratios (OR) for CVD prevalence, while Cox proportional regression estimated hazard ratios (HR) for mortality. Of 39,572 participants, 20.24 % were in the low group, 69.79 % in the moderate group, and 9.96 % in the high group. After adjusting for confounders, the CVD prevalence ORs for moderate and high groups were 1.19 (95 % CI: 1.05, 1.34) and 1.78 (95 % CI: 1.53, 2.07), respectively (P for trend <0.001). Compared to the low group, the high group had adjusted HRs of 1.92 (95 % CI: 1.54, 2.41) for all-cause mortality, 1.61 (95 % CI: 1.12, 2.34) for cardiovascular mortality, and 1.83 (95 % CI: 1.11, 3.02) for cancer-related mortality (all P for trend <0.01). These associations remained significant across all subgroups. Conclusion: NPS is an independent risk factor for CVD and is positively associated with all-cause and cardiovascular mortality in individuals with CVD.