Background: Cardiovascular disease (CVD) significantly increases in postmenopausal women. This study aims to investigate the potential association between red cell distribution width (RDW), the RDW-to-albumin ratio (RAR), and the prevalence of CVD in postmenopausal women.

Methods: This study analyzed data extracted from the National Health and Nutrition Examination Survey (NHANES) database spanning the years 2003-2016. Weighted multiple logistic regression models were used to evaluate the associations between RDW, RAR, and CVD. Smoothing curve fitting and generalized additive models were applied to explore potential nonlinear relationships. Subgroup analyses and interaction tests were conducted to investigate whether the associations between RDW, RAR, and CVD varied across different subpopulations. Sensitivity analyses were performed to assess the robustness of the findings.

Results: This study included a total of 7619 postmenopausal women, of whom 1181 had CVD. Logistic regression models revealed that for each unit increase in RDW and RAR, the risk of total CVD in postmenopausal women increased by 11% and 42%, respectively. When RDW and RAR were categorized into groups, the risk of CVD significantly increased with higher levels of RDW and RAR. Smoothing curve fitting demonstrated a nonlinear relationship between RDW, RAR, and total CVD. Subgroup analyses revealed that the positive associations between RDW, RAR, and CVD were particularly significant in individuals
aged ≥60 years and with a body mass index (BMI) ≥25 kg/m².

Conclusion: Higher RDW and RAR in postmenopausal women are positively associated with an increased risk of CVD, supporting the potential use of RDW and RAR as risk bio-markers for CVD in this population.