Abstract
The neutrophil-to-high-density lipoprotein cholesterol ratio (NHR) is a composite biomarker reflecting systemic inflammation and lipid metabolism. We examined associations between NHR and cardiovascular disease (CVD) in patients with chronic obstructive pulmonary disease (COPD). This cross-sectional study analyzed National Health and Nutrition Examination Survey data (2007–2018) including adults aged ≥40 years with COPD. CVD was defined as self-reported heart failure, coronary artery disease, angina, or myocardial infarction. NHR was calculated as neutrophil count (×10
3
/μL) divided by high-density lipoprotein cholesterol (mmol/L). Multivariable logistic regression assessed NHR–CVD associations, with restricted cubic splines evaluating dose–response relationships. Among 1033 COPD patients, 199 (19.3%) had CVD. After multivariable adjustment, each unit increase in NHR was associated with higher CVD odds ratio (OR: 1.24, 95% confidence interval [CI]: 1.11–1.38). Compared to the lowest quartile,
Q
3 (OR: 1.65, 95% CI: 1.04–2.85) and
Q
4 (OR: 2.60, 95% CI: 1.52–4.52) showed higher CVD odds. Spline analysis revealed a nonlinear relationship with a potential inflection point around NHR ≈ 3.4. Associations remained consistent across subgroups. Elevated NHR is independently associated with higher CVD prevalence in COPD patients. This cross-sectional analysis suggests NHR may serve as an accessible inflammatory biomarker reflecting cardiovascular comorbidity in this population.