The role of C-reactive protein to lymphocyte ratio and sleep duration in heart failure: exploring the mechanistic interplay and clinical implications

Abstract

Heart failure (HF) is a progressive disease with complex pathogenesis involving inflammation, immune dysfunction, and metabolic abnormalities. Although C-reactive protein (CRP) is an established HF marker, the CRP-to-lymphocyte ratio (CLR) integrates inflammatory and immune responses. Sleep duration is also critical for cardiovascular health, but the joint impact of CLR and sleep on HF remains unclear. This study examined their association using 14,900 participants (659 with HF) from 2015 to 2023 NHANES data. CLR was calculated as high-sensitivity CRP divided by lymphocyte count, and sleep duration was self-reported. Multivariable logistic regression analyzed the relationships, adjusting for demographic and clinical confounders. Restricted cubic spline models assessed nonlinearity, and subgroup analyses were performed. Higher CLR was strongly associated with increased HF risk (highest quartile OR = 7.49, 95% CI: 5.89–9.52, p < 0.001). Short sleep (< 7 h) also correlated with a higher risk (OR = 1.60, 95% CI: 1.25–2.54, p = 0.017). Nonlinear trends revealed inflection points for CLR (7.83, 11.05) and sleep duration (6.97, 7.07 h), with extreme values linked to greater risk. In conclusion, both elevated CLR and inadequate sleep are independent risk factors for HF, emphasizing their combined role in HF pathogenesis. Further research should investigate underlying mechanisms and assess whether targeting inflammation and sleep can improve HF outcomes.