Monocyte/lymphocyte ratio as a risk factor of cardiovascular and all-cause mortality in coronary artery disease with low-density lipoprotein cholesterol levels below 1.4 mmol/L: A large longitudinal multicenter study

Association between neutrophil-lymphocyte ratio levels and mortality related to cardiovascular cause and all causes in coronary artery disease patients with low-density lipoprotein cholesterol below 1.4 mmol/L: A multicenter cohort study

BACKGROUND AND AIMS

Neutrophil-lymphocyte ratio (NLR) can reflect the residual risk of patients with coronary atherosclerotic disease (CAD). However, in CAD patients with low density lipoprotein cholesterol (LDL-C) less than 1.4 mmol/L, the relationship between NLR and poor prognosis remains unclear. The purpose of this research is to examine the relationship between NLR and mortality from cardiovascular causes as well as all causes in the study group.

METHODS AND RESULTS

From the beginning of 2007 to the end of 2020, 2749 individuals with LDL-C under 1.4 mmol/L at baseline and CAD diagnosed via coronary angiography were part of this research. The selected population was divided into four groups according to the level of NLR, and Cox regression model was used mainly to evaluate the association between NLR and cardiovascular and all-cause mortality. After a follow-up of median 6 years, a total of 182 cardiovascular deaths and 460 all-cause deaths had occurred. The Cox regression analysis of fully adjusted model showed that an elevated NLR is connected to a higher risk of mortality from cardiovascular cause (HR: 2.18, 95 %CI: 1.38-3.43) and all causes (HR: 1.33, 95 %CI: 1.02-1.74) in the fourth quartile group. Subgroup analysis indicated that younger and middle-aged patients, as well as those with multivessel coronary artery disease, may have a heightened residual risk of inflammation.

CONCLUSION

NLR can be a useful risk factor indicator for cardiovascular and all-cause mortality in CAD patients with LDL-C levels below 1.4 mmol/L, and it also points to residual risk.

Increased monocytes and their derived indicators are associated with clinical severity of acute heart failure following acute myocardial infarction

Objective

Monocytes play a significant role in the pathophysiology of acute myocardial infarction (AMI). The relationship between monocytes, their derived indicators, and the severity of acute heart failure following AMI remains unclear. Therefore, this study aims to investigate the association of monocytes and their derived indicators with clinical severity of acute heart failure in the patients with AMI.

Methods

In total of 173 patients with AMI were enrolled in this retrospective study. The demographic data and relevant medical histories were obtained. Monocytes and lipid levels were measured. All patients were divided into two groups based on killip classification. Killip class III-IV was defined as acute severe heart failure, while killip class I-II was defined as acute non-severe heart failure.

Results

Monocyte count, monocyte-to-white blood cell ratio, and monocyte-to-lymphocyte ratio were significantly higher in patients with acute severe heart failure compared to those with acute non-severe heart failure (P < 0.05). Multivariate logistic regression analysis showed that monocyte count, monocyte-to-white blood cell ratio, and monocyte-to-lymphocyte ratio were independently associated with acute severe heart failure (P < 0.05). Moreover, monocyte count, monocyte-to-white blood cell ratio, and monocyte-to-lymphocyte ratio were linked to NT-proBNP concentrations (P < 0.05). Receiver-operating characteristic curve analysis showed that monocyte count, monocyte-to-white blood cell ratio, and monocyte-to-lymphocyte ratio could identify acute severe heart failure in patients following AMI to some extent (P < 0.05).

Conclusion

The elevation of monocyte count, monocyte-to-white blood cell ratio, and monocyte-to-lymphocyte ratio correlated with clinical severity of acute heart failure following AMI, and offered potential discriminating value for cardiogenic pulmonary edema and shock following AMI.

Biomarkers of Inflammation and Association with Cardiovascular Magnetic Resonance Imaging for Risk Stratification and Outcome in Patients with Severe Aortic Stenosis

Background: Inflammatory indices have been proposed as simple and routinely obtainable markers of systemic inflammation in cardiac disease. This study investigated whether the neutrophil-to-lymphocyte ratio (NLR), the monocyte-to-lymphocyte ratio (MLR), and the pan-immune inflammation value (PIV) serve as biomarkers for risk stratification and outcomes measures in patients with severe aortic stenosis (AS) following valve replacement (AVR). Methods: In this retrospective analysis (January 2017-June 2022), patients with AS underwent pre-procedural cardiovascular magnetic resonance (CMR) imaging and were assigned a treatment strategy by a multidisciplinary Heart Team: (1) transcatheter AVR, (2) surgical AVR, or (3) no valvular intervention. Kaplan-Meier estimates and regression analyses were used to demonstrate associations between the NLR, MLR, and PIV with myocardial fibrosis-assessed by late gadolinium enhancement (LGE) and extracellular volume (ECV) on CMR-and a combined endpoint of heart failure hospitalizations and all-cause mortality. Results: A total of 356 patients (median age: 80 years, 50% male) were followed for a median of 40 months, during which 162 (46%) reached the combined endpoint. Linear regression identified C-reactive protein, but not the presence of LGE or elevated ECV, as the only independent predictor of all three inflammatory indices (p for all <0.001). After multivariable adjustment for clinical (EuroSCORE II), laboratory (baseline N-terminal prohormone of brain natriuretic peptide [NT-proBNP] and C-reactive protein), and imaging parameters (AV mean pressure gradient, right ventricular ejection fraction, and ECV), the above-the-upper-quartile NLR (adjusted hazard ratio [aHR]: 1.45, 95%-confidence interval [CI]: 1.01-1.92, p = 0.042), MLR (aHR: 1.48, 95%-CI: 1.05-2.09, p = 0.025), and PIV (aHR: 1.56, 95%-CI: 1.11-2.21, p = 0.011) remained significantly associated with adverse outcomes. Following AVR, the median NLR (3.5 to 3.4) and PIV (460 to 376) showed a significant post-procedural decline compared to baseline (p ≤ 0.019 for both). Conclusions: Inflammatory indices are readily available biomarkers independently associated with adverse outcomes in severe AS following AVR. However, no significant relationship was observed between the NLR, MLR, PIV, and myocardial fibrosis on CMR.

Inflammatory and Lipid Biomarkers in Early Atherosclerosis: A Comprehensive Analysis

INTRODUCTION

Atherosclerosis is a leading cause of cardiovascular disease, characterized by lipid accumulation and chronic inflammation within arterial walls. Early detection in young adults is crucial for preventing adverse cardiovascular events. This study investigates the associations between inflammatory indices, lipid biomarkers, and the presence of atherosclerosis in patients aged 18 to 55 years.

METHODS

A cross-sectional study was conducted involving 89 participants divided into two groups: 62 patients with documented atherosclerosis (main group) and 27 healthy controls without significant atherosclerosis. Comprehensive data-including demographic information, medication use, imaging results, laboratory parameters, and calculated inflammatory indices (SIRI, SII, AISI, NLR, PLR, MLR)-were collected. Statistical analyses included correlation assessments, group comparisons using the Mann-Whitney U test, logistic regression modeling, feature importance analysis with Random Forest and Gradient Boosting classifiers, receiver operating characteristic (ROC) curves, and K-means clustering.

RESULTS

Significant differences were observed between the main and control groups. Patients with atherosclerosis exhibited elevated inflammatory indices (SIRI, NLR, MLR, SII) and lipid profile abnormalities (higher TC and LDL-C, lower HDL-C). Lp(a) and ANGPTL3 levels were significantly higher in the main group (p < 0.001 and p < 0.01, respectively). Logistic regression identified SIRI and ANGPTL3 as significant predictors of atherosclerosis, with the model demonstrating high accuracy (77%) and sensitivity (93%). Feature importance analysis confirmed the significance of SIRI and ANGPTL3, alongside traditional lipid biomarkers, in predicting disease presence. ROC analysis showed excellent model performance (AUC > 0.80). Clustering analysis revealed two distinct patient subgroups characterized by predominant inflammatory profiles or lipid metabolism disturbances.

CONCLUSIONS

Systemic inflammation and lipid abnormalities play significant roles in early atherosclerosis among young adults. Elevated SIRI and ANGPTL3 levels are potent predictors of disease presence. The integration of inflammatory indices and lipid biomarkers into predictive models enhances risk stratification and supports personalized medicine approaches.