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The objective of this research is to explore the possible link between the neutrophil-to-albumin ratio (NPAR) and the occurrence of PAD.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>In this cross-sectional study of the National Health and Nutrition Examination Survey (NHANES) 199\u20132004, data from 5,470 participants were analyzed. The Ankle-brachial index (ABI) was obtained by dividing the mean systolic blood pressure in the ankle by the mean blood pressure in the arm. PAD was characterized by an ABI value of less than 0.9 in either leg. Patients diagnosed with PAD and those without, all of whom had detailed NPAR data from NHANES. Weighted multivariable logistic regression models were used to analyze the relationship between free NPAR and PAD. The nonlinear relationship between NPAR and PAD was investigated using restricted cubic splines. Additionally, subgroup analyses and interaction tests were carried out to provide further understanding.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>This study analyzed data from 31,126 NHANES participants (1999\u20132004), focusing on those aged\u2009\u2265\u200940 years undergoing ABI tests (<jats:italic>n<\/jats:italic>\u2009=\u20099,970). After exclusions, the final sample was 5,470 participants, representing 79,363,231 U.S. adults. The weighted prevalence of peripheral artery disease (PAD) was 3.75% (95% CI: 3.20\u20134.38%). Logistic regression analysis revealed significant associations between higher NPAR levels and increased prevalence of PAD. In the adjusted models, the odds ratios (ORs) for the highest versus the lowest NPAR tertile were significant (OR: 1.18, 95% CI: 1.05\u20131.33). Restricted cubic spline (RCS) analysis showed a positive correlation between NPAR and PAD prevalence (overall <jats:italic>p<\/jats:italic>\u2009=\u20090.005), though the nonlinear effect was not statistically significant (<jats:italic>p<\/jats:italic>\u2009=\u20090.504). Stratified analyses indicated significant associations in specific subgroups, such as males (OR: 1.18, 95% CI: 1.10\u20131.27) and non-diabetics (OR: 1.12, 95% CI: 1.06\u20131.18), those without CVD (OR: 1.10, 95% CI: 1.04, 1.16), white participants (OR: 1.11, 95% CI: 1.03\u20131.19), moderate drinkers (OR: 1.14, 95% CI: 1.05\u20131.25), heavy drinkers (OR:1.19, (95% CI: 1.06\u20131.33), sedentary individuals (OR:1.10, 95% CI: 1.01\u20131.19), and former smokers (OR:1.12, 95% CI: 1.04\u20131.21).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Our study demonstrates a positive correlation between NPAR levels and the prevalence of PAD, implying that elevated NPAR levels are linked to a greater probability of developing PAD. As a cross-sectional study, it cannot establish the temporal sequence of events or causality.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12872-025-05001-2","type":"journal-article","created":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T04:06:56Z","timestamp":1753070816000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Association between neutrophil percentage-to-albumin ratio and prevalence peripheral artery disease in U.S. adults: a cross-sectional study from the NHANES"],"prefix":"10.1186","volume":"25","author":[{"given":"Shou-yi","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qianq","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A-bing","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang-kai","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,21]]},"reference":[{"issue":"3","key":"5001_CR1","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1161\/ATVBAHA.119.312142","volume":"40","author":"GH Bevan","year":"2020","unstructured":"Bevan GH, White Solaru KT. 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