Abstract
Heart failure (HF) is closely linked to platelet counts and lipid levels. The platelet-to-high-density lipoprotein cholesterol ratio (PHR) is a novel marker for assessing cardiovascular disease. This study investigates the relationship between PHR and HF. We analyzed data from ten consecutive NHANES survey cycles (1998-2018), focusing on self-reported HF diagnoses with complete PHR information. PHR was calculated as platelet count divided by HDL-C (mmol/L). A multivariate logistic regression model was used to examine the association between PHR and HF, with subgroup analyses to identify potential influencing factors. RCS curve plotting and threshold effect analysis were employed to describe non-linear relationships. The study included 31,410 adults aged 20-85 years. The multivariate logistic regression indicated that individuals with the highest PHR had 82% increased likelihood of HF compared to those with the lowest PHR (OR = 1.82; 95% CI, 1.37-2.40, P < 0.001). Subgroup analyses revealed no significant interactions between PHR and specific subgroups (P > 0.05), except in those with alcohol consumption (yes/no) and BMI subgroups (P < 0.05). The association between PHR and HF was non-linear, with a notable turning point at 281.53. Elevated PHR is significantly associated with HF, suggesting it may serve as an effective clinical indicator for monitoring HF risk. Larger prospective cohort studies are needed to validate these findings and further assess the clinical utility of PHR in cardiovascular risk assessment.