Association between lipid accumulation product and the prevalence of peripheral artery disease: A cross-sectional study based on NHANES 1999‒2004

Background This study aimed to evaluate the association between Lipid Accumulation Product (LAP) and the prevalence of Peripheral Artery Disease (PAD) among US adults using nationally representative data from the National Health and Nutrition Examination Survey (NHANES). Methods Data from NHANES conducted between 1999 and 2004 were utilized for this analysis. Survey-weighted logistic regression models were used to examine the association between Log-transformed LAP (Ln-LAP) and PAD prevalence, with Ln-LAP analyzed both as a continuous variable and according to tertiles. Restricted cubic spline analysis was performed to assess the dose–response relationship. Prespecified subgroup analyses and exploratory machine-learning analyses using random forest and Light Gradient Boosting Machine models were also conducted. Results Among 5,202 participants, 287 had PAD. The findings indicate a significant positive association between the natural logarithm of LAP (Ln-LAP) and the prevalence of PAD. After adjustment for potential confounders, each one-unit increase in Ln-LAP was associated with 36% higher odds of prevalent PAD (OR = 1.36, 95% CI 1.18–1.58). Notably, this association is particularly pronounced in specific subgroups, including women, individuals with estimated Glomerular Filtration Rate (eGFR) less than 60 mL/min/1.73 m 2 , and those who were high school graduates or above. In exploratory machine-learning analyses, Ln-LAP showed relatively high feature importance for PAD classification. Conclusion Our study suggests a notable positive association between LAP levels and the prevalence of PAD. The association appeared to be approximately linear and may be more pronounced in specific subgroups. Given the cross-sectional design, causal inference cannot be made.