Association between Blood Urea Nitrogen-to-Serum Albumin Ratio and Cardiovascular Disease Risk: A NHANES Study

Background Cardiovascular disease (CVD) ranks among the top causes of mortality worldwide, particularly impacting the US. The Blood Urea Nitrogen-to-Serum Albumin Ratio (BAR) has recently been identified as a promising biomarker that integrates indicators of both renal and nutritional health. However, the association between BAR and CVD has not been thoroughly explored. Methods This study utilized cross-sectional data from individuals aged ≥ 20 years who participated in the NHANES from 2011–2018. To evaluate the stability of the findings, cubic spline models with restricted parameters along with logistic regression were employed, and both subgroup analyses and Receiver Operating Characteristic (ROC) curve analyses were conducted. Results There were 19770 participants, 10.5% (2085/19770) were diagnosed with CVD. When BAR was analyzed as a continuous variable, the full model-adjusted OR was 1.06 (95% CI: 1.02 ~ 1.09, p = 0.003). When compared with Q2, the OR values for Q1, Q3, and Q4 groups were 1.21 (95% CI: 1.01 ~ 1.46), 1.09 (95% CI: 0.92 ~ 1.29), and 1.31 (95% CI: 1.11 ~ 1.53), respectively. The correlation between BAR and CVD showed a U-shaped curve (p _{for non−linear} < 0.001). The threshold analysis resulted in a 2.49. Subgroup analyses did not reveal any significant interactions with BAR across the different subgroups (all p > 0.05). The ROC curve demonstrated an area under the curve (AUC) of 0.685 (95% CI: 0.672–0.698), indicating BAR's ability to predict CVD. Conclusion BAR is a potential predictor of CVD risk with a U-shaped association. Further prospective studies are required to validate our findings.