Association Between Platelet to High-Density Lipoprotein Cholesterol Ratio and Risk of Diabetes and Prediabetes: Recent Findings from NHANES 2005– 2018

Purpose: To explore the relationship between the platelet-to-high-density lipoprotein cholesterol ratio (PHR) and the risk of diabetes and prediabetes. Methods: This study analyzes data from the 2005-2018 National Health and Nutrition Examination Survey (NHANES). The prevalence of diabetes and prediabetes, as well as levels of HDL-C and platelet counts, were derived from cross-sectional surveys. The PHR was calculated by dividing platelet count by HDL-C concentration, and diabetes or prediabetes were classified according to established clinical criteria. We used multivariate logistic regression analyses to estimate odds ratios (ORs) and 95% CIs. The logistic regression models were classified into categorical and continuous models. The potential non-linear relationship was assessed using restricted cubic splines (RCSs) and two-piecewise linear regression to identify any inflection points. Additionally, subgroup and interaction analyses were conducted to determine variations across different population groups. Result: A total of 20,229 eligible participants were included in the study, with a mean age of 47.84 years, and 51.80% of them were female. Among these participants, 3,884 (14.29%) were diagnosed with diabetes, and 8,863 (44.36%) were prediabetes. The result showed a positive association between PHR and the risk of diabetes and prediabetes. After adjusting for model 3, the OR for diabetes and prediabetes was associated with a per unit increase in PHR of 1.14 (95% CI: 1.00–1.29, P<0.05). The OR for participants in the highest PHR quartile was 2.46 (95% CI: 1.34–4.51, P<0.01) compared to those in the lowest quartile. Two-piecewise regression analysis identified a breakpoint at PHR = 4.55, with a positive association observed when PHR was below this value (OR = 1.32, 95% CI: 1.01–1.73, P<0.05). Subgroup and interaction analyses demonstrated that the positive association remained consistent across various demographic groups. Conclusions: Our study indicates that a higher PHR may be associated with an increased risk of developing diabetes and prediabetes. Therefore, PHR could potentially be used as a marker for assessing the likelihood of these conditions.