Lymphocyte to High-Density Lipoprotein Ratio but Not Platelet to Lymphocyte Ratio Effectively Predicts Metabolic Syndrome Among Subjects From Rural China

Sex differences in associations of metabolic inflammation and insulin resistance with incident type 2 diabetes mellitus: a retrospective cohort of adults with annual health examinations

BACKGROUND AND AIMS

Cardio-kidney-metabolic diseases are major causes of premature death worldwide, with type 2 diabetes mellitus (T2DM) playing a critical role. Inflammation and insulin resistance have been implicated in the pathogenesis of T2DM. This study aimed to investigate the sex-specific associations of metabolic inflammation and insulin resistance with incident T2DM to support personalized prevention and management strategies.

METHODS

A retrospective cohort was used to analyse annual health examination data from the general practice department of a general hospital in Shanghai between 2021 and 2023. After excluding participants diagnosed with T2DM, cardiovascular disease or chronic kidney disease at baseline, 1214 adults were followed up for two years. Cox proportional hazards and logistic regression models were used to assess the associations of triglyceride-glucose body mass index (TyG-BMI), the lymphocyte/high-density lipoprotein cholesterol ratio (LHR), the monocyte/high-density lipoprotein cholesterol ratio (MHR), and the neutrophil/high-density lipoprotein cholesterol ratio (NHR) with incident T2DM.

RESULTS

In the total population, TyG-BMI (all HR/OR > 1, P < 0.05), LHR, MHR and NHR were significantly and positively associated with incident T2DM. TyG-BMI was significantly associated with incident T2DM in men (both HR/OR > 1, P < 0.05), whereas LHR, MHR and NHR were strongly associated with incident T2DM in women (all HR/OR > 1, P < 0.05). The interaction effect between LHR and sex was statistically significant.

CONCLUSION

Sex differences play an important role in incident T2DM. Men should be aware of weight control to avoid obesity-related insulin resistance, whereas women should monitor metabolic inflammation indicators such as LHR for early detection and intervention of their T2DM risk.

Lymphocyte to High-density Lipoprotein Cholesterol Ratio is Positively Associated with Pre-diabetes, Metabolic Syndrome, and Non-traditional Cardiometabolic Risk Markers: A Cross-sectional Study at Secondary Health Care

High scores of lymphocyte-to-high-density lipoprotein cholesterol ratio (lymphocyte-to-HDL-c) may be a new indicator of inflammation and metabolic syndrome. Here, we investigated the associations of the lymphocyte-to-HDL-c with traditional and non-traditional cardiometabolic risk markers in subjects at high cardiovascular risk. This study is a cross-sectional analysis with subjects assisted in a Secondary Health Care (n = 581, age = 63.06 ± 13.86 years; 52.3% women). Lymphocyte-to-HDL-c ratio were assessed by routine laboratory tests. Anthropometric and/or biochemical variables were used to calculate traditional (body mass index - BMI, and waist-to-height ratio - WHtR) and non-traditional (lipid accumulation product index-LAP, visceral adiposity index-VAI, deep-abdominal-adipose-tissue index-DAAT, atherogenic index of plasma-AIP, and waist-hypertriglyceridemic phenotype-HTGW) cardiometabolic risk markers. Furthermore, anthropometric measurement waist circumference (WC), blood pressure, metabolic syndrome (MS), and biochemical markers (lipid and glycemic profile) were considered traditional markers of cardiometabolic risk. Pearson's chi-square test, Poisson regression with robust variance, or multinomial logistic regression were performed (α = 0.05). Individuals with a high lymphocyte-HDL-c ratio (> 0.84, 3rd tertile) were associated with the HTGW phenotype, high VAI, high LAP, hypertriglyceridemia, high AIP, high very low-density lipoprotein-cholesterol (VLDL-c), pre-diabetes, and 3 and 4 MS components compared with individuals in the first tertile, independent of confounders. Our findings supported the lymphocyte-to-HDL-c ratio as a potential biomarker during the screening of subjects at high cardiovascular risk.

Association between lymphocyte to high-density lipoprotein cholesterol ratio and insulin resistance and metabolic syndrome in US adults: results from NHANES 2007-2018

BACKGROUND

Insulin resistance (IR) and metabolic syndrome (MetS) are significant global health challenges that increase the risk of various chronic diseases. The lymphocyte-to-high-density lipoprotein cholesterol ratio (LHR) has emerged as a novel inflammatory metabolic marker. The present study focused on evaluating the association between the LHR and both IR and MetS.

METHODS

We analyzed data from 14,779 adults aged ≥ 20 years from the National Health and Nutrition Examination Survey (2007-2018). To investigate the relationship between LHR and both IR and MetS, we conducted multivariable logistic regression analyses. The reliability of the results was validated through both stratified and sensitivity analyses. Furthermore, we thoroughly examined possible nonlinear associations by implementing a restricted cubic spline in conjunction with a threshold effect analysis.

RESULTS

Compared to the lowest LHR quartile, individuals in the highest quartile indicated significantly increased prevalence of IR (odds ratio = 3.72, 95% confidence intervals: 3.01-4.59) and MetS (odds ratio = 11.38, 95% confidence intervals: 8.85-14.63) in fully adjusted models. Subgroup analyses demonstrated that the association between the LHR and IR remained consistent across all subgroups, with no significant interaction effect observed. However, the association between LHR and MetS was more pronounced in female participants. Restricted cubic spline analyses revealed nonlinear associations between LHR and both IR and MetS. The threshold effect analyses identified inflection points at 0.055 for these non-linear relationships.

CONCLUSIONS

An elevated LHR was positively associated with the prevalence of IR and MetS, indicating its promising role in early screening and disease prevention through biological monitoring.

Prognostic Value of Neutrophil, Monocyte, Lymphocyte, and Platelet/High-Density Lipoprotein Ratios in Ischemic Heart Disease: An NHANES Analysis

The prognostic value of easily accessible hematologic biomarkers, such as the neutrophil-to-HDL ratio, as well as the monocyte-to-HDL, lymphocyte-to-HDL, and platelet-to-HDL ratios, remains underexplored in patients with established ischemic heart disease (IHD). Community-dwelling adults aged ≥ 20 with established IHD from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 were eligible. Mortality was tracked through linkage to the National Death Index (NDI) until the end of 2019. Cox regressions examined the associations between these hematologic ratios and all-cause mortality. Receiver operating characteristic (ROC) curve analysis assessed the predictive accuracy of these ratios for mortality. A total of 2265 patients were analyzed, with a median follow-up period of 80 months. After adjusting for demographic factors, lifestyle variables, and comorbidities, patients in the highest quartile of the neutrophil/HDL had a significantly increased all-cause mortality risk (aHR = 1.41, 95% CI: 1.13-1.77) compared to those in the lowest quartile. No significant associations were found between the other ratios and mortality. In conclusion, this study found that among the hematologic ratios analyzed, an elevated neutrophil-to-HDL ratio has the strongest potential for mortality risk stratification in community-dwelling patients with ischemic heart disease in the US, offering important guidance for both patients and clinicians.

The association between neutrophil and lymphocyte to high-density lipoprotein cholesterol ratio and metabolic syndrome among Iranian population, finding from Bandare Kong cohort study

BACKGROUND

Metabolic Syndrome (MetS) is characterized by the co-occurrence of various metabolic risk factors, significantly increasing the risk of cardiovascular diseases (CVD) and type 2 diabetes (T2DM). This study investigates the potential of hematological indices, specifically the neutrophil to high-density lipoprotein cholesterol ratio (NHR) and lymphocyte to high-density lipoprotein cholesterol ratio (LHR), as predictors of MetS in a population from southern Iran.

METHODS

Utilizing baseline data from the Bandare-Kong Non-Communicable Diseases (BKNCD) Cohort, part of the Prospective Epidemiological Research Studies in IrAN (PERSIAN), A total of 2,684 participants aged 35-70 years were analyzed. Participants were evaluated using the Iranian National Cholesterol Education Program (NCEP) criteria to diagnose MetS. Receiver operating characteristic (ROC) analysis was conducted to assess the predictive validity of NHR and LHR across different demographic categories.

RESULTS

The mean LHR and NHR values were significantly higher in individuals diagnosed with MetS (P < 0.001). Specifically, the LHR was 0.85 ± 0.26 in MetS patients compared to 0.76 ± 0.23 in those without MetS, while the NHR was 1.33 ± 0.35 in MetS patients compared to 1.20 ± 0.32 in those without MetS. After adjusting for confounding factors, both LHR and NHR remained significantly associated with MetS, with odds ratios (OR) of 6.61 (95% CI: 4.43-9.83) for LHR and 4.76 (95% CI: 3.51-6.45) for NHR. Among MetS components, LHR was associated with low HDL cholesterol and elevated triglycerides, while NHR showed significant associations with central obesity, low HDL cholesterol, and elevated triglycerides. ROC analysis revealed moderate predictive capabilities for both indices, with areas under the curve of 0.60 for LHR and 0.61 for NHR.

CONCLUSION

The findings suggest that NHR and LHR are promising, easily obtainable hematological markers for predicting MetS. These indices could serve as valuable tools for early detection and ongoing monitoring in clinical settings, aiding in the prevention and management of MetS.

Association between high-density lipoprotein-related inflammation index and periodontitis: insights from NHANES 2009-2014

BACKGROUND

Periodontitis, a persistent inflammatory condition, significantly impairs individuals' overall quality of life. Lymphocyte-to-high-density lipoprotein cholesterol ratio (LHR), monocyte-to-high-density lipoprotein cholesterol ratio (MHR), neutrophil-to-high-density lipoprotein cholesterol ratio (NHR), and platelet-to-high-density lipoprotein cholesterol ratio (PHR) are new convenient and economical biomarkers. However, whether the above high-density lipoprotein-related inflammatory biomarkers are associated with periodontitis has rarely been investigated. Therefore, the research endeavor focused on uncovering potential relationships.

METHODS

The research encompassed a diverse and extensive sample, comprising 9,470 participants, selected from the National Health and Nutrition Examination Survey spanning the years 2009 to 2014. The association between high-density lipoprotein-related inflammatory biomarkers and periodontitis was explored utilizing a multivariable logistic regression model with weighted analysis. Additionally, the study employed smoothed curve fitting to explore potential nonlinear relationships. Further stratified analyses and interaction tests were performed.

RESULTS

This study indicated no apparent association between MHR and PHR with periodontitis, whereas LHR and NHR demonstrated a statistically significant positive relationship with the prevalence of periodontitis. In the fully adjusted model, participants belonging to the highest tertile of both LHR and NHR showed a notably higher likelihood of having periodontitis compared to those in the lowest tertile (LHR: OR = 1.22, 95% CI: 1.06, 1.39; NHR: OR = 1.27, 95% CI: 1.09, 1.49). Furthermore, smooth curve fitting was employed to investigate the potential nonlinear relationship between LHR, NHR, and periodontitis. The results indicated that there was a significant increase in the occurrence of periodontitis when Log2 (LHR) exceeded 1.01 and Log2(NHR) surpassed 2.16 (Log2(LHR): OR = 1.42; 95% CI: 1.19, 1.69; Log2(NHR): OR = 1.40; 95% CI: 1.15, 1.71). The subgroup analysis revealed that the associations between periodontitis and either LHR or NHR, separately, were more pronounced among individuals under the age of 50 and those without hypertension.

CONCLUSIONS

This cross-sectional study revealed a positive relationship between LHR、NHR and periodontitis, particularly when these indicators exceeded their thresholds. LHR and NHR may serve as potential inflammatory markers for identifying periodontitis, thereby facilitating early warning for both patients and dentists, and enabling early intervention in the oral environment. Besides, extensive prospective cohort investigations are essential to confirm and solidify this observation.

Immune-inflammatory biomarkers for the occurrence of MACE in patients with myocardial infarction with non-obstructive coronary arteries

Background

Neutrophil-to-high-density lipoprotein cholesterol ratio (NHR), monocyte-to-high-density lipoprotein cholesterol ratio (MHR), lymphocyte-to-high-density lipoprotein cholesterol ratio (LHR), platelet-to-high-density lipoprotein cholesterol ratio (PHR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI) have been identified as immune-inflammatory biomarkers associated with the prognosis of cardiovascular diseases. However, the relationship of these biomarkers with the prognosis of myocardial infarction with non-obstructive coronary arteries (MINOCA) remains unclear.

Method

Patients with MINOCA who underwent coronary angiography at the 920th Hospital of Joint Logistics Support Force were included in our study. Clinical baseline characteristics and laboratory testing data were collected from the hospital record system. The patients were divided into two groups on the basis of major adverse cardiovascular events (MACE) occurrence. Multiple logistic regression analysis was conducted to assess the relationship between NHR, MHR, LHR, PHR, SII, SIRI, AISI, and MACE. Receiver operating characteristic (ROC) curves were generated to evaluate the predictive value of NHR, MHR, LHR, PHR, SII, SIRI, and AISI for MACE in patients with MINOCA. The accuracy of the prediction was indicated by the area under the curve (AUC) value.

Results

The study included 335 patients with MINOCA. (81 in the MACE group and 254 in the No-MACE group). The MACE group had higher levels of NHR, MHR, LHR, PHR, SII, SIRI, and AISI than the No-MACE group. Multiple logistic regression analysis adjusted for confounding factors indicated that the higher levels of NHR, MHR, PHR, SII, SIRI, and AISI were associated with the occurrence of MACE in patients with MINOCA (P < 0.001). The AUC values for NHR, MHR, PHR, SII, SIRI, and AISI were 0.695, 0.747, 0.674, 0.673, 0.688, and 0.676, respectively. The combination of NHR, MHR, PHR, SII, SIRI, and AISI improved the accuracy of predicting MACE in patients with MINOCA (AUC = 0.804).

Conclusion

Higher levels of NHR, MHR, PHR, SII, SIRI, and AISI were associated with the occurrence of MACE, and the combination of NHR, MHR, PHR, SII, SIRI, and AISI improved the accuracy for predicting the incidence of MACE events in patients with MINOCA.

Effect of isotretinoin treatment on inflammatory and hematological parameters in patients with acne vulgaris

PURPOSE

Although the inflammatory and anti-inflammatory effects of isotretinoin (ISO) treatment in patients with acne vulgaris have been discussed in the literature in recent years, no sensitive and specific marker has been found in studies so far. Neutrophil/HDL (high-density lipoprotein) (NHR), lymphocyte/HD L(LHR), platelet/HDL (PHR), and lymphocyte/monocyte (LMR) are new biomarkers related to inflammation. Triglyceride/HDL (TG/HDL), LDL/HDL, and total cholesterol/HDL have been shown to be cardiometabolic risk factors predicting both cardiovascular disease risk and metabolic risk, rather than just a simple dyslipidemia scale. To our knowledge, the relationship between these parameters and ISO treatment has never been studied before. We aimed to evaluate the immuno-inflammatory response of ISO treatment in patients with acne vulgaris with NHR, LHR, PHR, LMR, TG/HDL, LDL/HDL, and total cholesterol/HDL parameters.

MATERIALS AND METHODS

In this study, 153 patients who received oral ISO treatment for at least 3 months with a diagnosis of moderate-severe acne vulgaris were evaluated retrospectively. Patients were given oral isotretinoin at a dose of 0.5-1 mg/kg. Pre and post-treatment leukocyte (WBC), neutrophil (NE), lymphocyte (LY), platelet (PLT), red cell distribution width (RDW), plateletcrit (PCT), neutrophil/lymphocyte (NLR), platelet/lymphocyte (PLR), mean platelet volume (MPV), monocyte/lymphocyte (MLR), LMR, total cholesterol, LDL cholesterol, HDL cholesterol, triglyceride, MHR, NHR, LHR, PHR, TG/HDL, total cholesterol/HDL, LDL/HDL parameters were evaluated.

RESULTS

It was found that post-treatment WBC and MPV values increased statistically significantly; NLR, neutrophil, and PCT values, on the other hand, decreased significantly (p < 0.05). No statistically significant change was detected in PLR, MLR, LMR, MHR, NHR, LHR, PHR, lymphocyte, monocyte, platelet, and RDW parameters (p > 0.05). It was determined that post-treatment total cholesterol, triglyceride, VLDL, and LDL levels increased statistically significantly; however, the HDL level decreased significantly (p < 0.05). Levels of total cholesterol/HDL, TG/HDL, and LDL/HDL were also found to increase statistically significantly (p < 0.05).

CONCLUSION

Our study suggests that the MPV and NLR ratio as biomarkers can be used as indicators of atherosclerosis-related inflammation due to ISO treatment, but the MHR, NHR, LHR, PHR, MLR, LMR ratios cannot be used. Moreover, we believe that the ratios of TG/HDL, LDL/HDL, and total cholesterol/HDL offer a new contribution as indicators of cardiovascular risk and systemic inflammation related to ISO treatment.

The association between lymphocyte to high-density lipoprotein ratio and depression: Data from NHANES 2015-2018

INTRODUCTION

The relationship of lymphocyte to high-density lipoprotein ratio (LHR) with depression remains uncertain. We aimed to evaluate the association between LHR and depression in US adults.

METHODS

In this cross-sectional study, a total of 4216 participants were enrolled from the National Health and Nutrition Examination Survey (2015-2018). Depressive symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9). Participants were classified as having depression if PHQ-9 scores were ≥10. Multiple logistic regression models were used to explore the relationship between the LHR and depression.

RESULTS

Overall, the LHR was significantly associated with depression (per standard deviation increment; adjusted odds ratio (OR), 1.31; 95% confidence interval (CI) [1.14, 1.50]) after adjusted potential variables. Interactions between LHR with metabolic syndrome (MetS) and body mass index (BMI) on the risk of depression were found in stratified analysis (p for interaction < .05).

CONCLUSIONS

A higher level of LHR was significantly associated with higher odds of having depression in US adults, and it was strengthened in participants with MetS or BMI ranging from 25 to 30 kg/m2 .

Complete Blood Count (CBC)-Derived Inflammation Indexes Are Useful in Predicting Metabolic Syndrome in Adults with Severe Obesity

Background: Metabolic syndrome (MetS) is a globally increasing pathological condition. Recent research highlighted the utility of complete blood count-derived (CBC) inflammation indexes to predict MetS in adults with obesity. Methods: This study examined CBC-derived inflammation indexes (NHR, LHR, MHR, PHR, SIRI, AISI, and SII) in 231 adults with severe obesity (88 males, 143 females; age: 52.3 [36.4-63.3] years), divided based on the presence (MetS+) or absence (MetS-) of MetS. The relationships between the indexes and the cardiometabolic risk biomarkers HOMA-IR, TG/HDL-C, and non-HDL-C were also evaluated. Results: Individuals with metabolic syndrome (MetS+) had significantly higher values of MHR, LHR, NHR, PHR, and SIRI than those without (MetS-) (MHR and NHR: p < 0.0001; LHR: p = 0.001; PHR: p = 0.011; SIRI: p = 0.021). These values were positively correlated with the degree of MetS severity. Logistic regression (MHR and NHR: p = 0.000; LHR: p = 0.002; PHR: p = 0.022; SIRI: p = 0.040) and ROC analysis (MHR: AUC = 0.6604; LHR: AUC = 0.6343; NHR: AUC = 0.6741; PHR: AUC = 0.6054; SIRI: AUC = 0.5955) confirmed the predictive potential of CBC-derived inflammation indexes for MetS in individuals with severe obesity. CBC-derived inflammation indexes also correlated with HOMA-IR (MHR, LHR, and NHR: p < 0.0001; PHR: p < 0.001; SIRI: p = 0.000) and TG/HDL-C (MHR, LHR, NHR and PHR: p < 0.0001; SIRI: p = 0.006). Conclusions: In conclusion, this study validates CBC-derived inflammation indexes for predicting MetS in individuals with severe obesity. The relationships between these indexes and cardiometabolic risk factors can enable clinicians to better grade MetS associated with obesity.

Association between multiple inflammatory biomarkers and remnant cholesterol levels in patients with percutaneous coronary intervention: A large-scale real-world study

BACKGROUND AND AIM

Remnant cholesterol (RC) has garnered increasing attention recently due to its association with adverse cardiovascular events. However, the relationship between RC levels and inflammation remains unclear. The goal of this study was to investigate and compare the predictive value of multiple inflammatory biomarkers for high RC in patients with percutaneous coronary intervention (PCI).

METHODS AND RESULTS

Initially, a total of 10,724 consecutive individuals hospitalized for PCI at Fu Wai Hospital in 2013 were enrolled. Finally, 9983 patients receiving dual antiplatelet therapy and drug-eluting stent were selected for analysis. The inflammatory biomarkers included high-sensitivity C-reactive protein (hs-CRP), hs-CRP-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), lymphocyte-to-hs-CRP ratio (LCR), and systemic immune-inflammation index (SII). Patients were divided into higher RC and lower RC groups based on the median RC level. Multivariate logistic regression showed that hs-CRP (OR per SD: 1.254), CAR (OR per SD: 1.245), PLR (OR per SD: 1.139), and SII (OR per SD: 1.077) were associated with high RC (≥median), while LCR (OR per SD: 0.792) was associated with low RC (

CONCLUSIONS

In PCI patients, hs-CRP, CAR, PLR, LCR, and SII were independently associated with RC levels. Among these inflammatory biomarkers, hs-CRP conferred better prediction for high RC. This investigation further supports the close relationship between inflammation and residual lipid risk biomarker RC.

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Key Words

• Inflammation
• Percutaneous coronary intervention
• Remnant cholesterol
• hs-CRP

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MESH Headings

• Humans
• C-Reactive Protein/analysis
• Percutaneous Coronary Intervention/adverse effects
• Drug-Eluting Stents
• Biomarkers
• Inflammation/diagnosis
• Inflammation/etiology

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Affiliation(s)

Jiawen Li Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, China
Kailun Yan Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, China
Pei Zhu Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, China
Jingjing Xu Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, China
Xiaofang Tang Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, China
Yulong Li Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, China
Weixian Yang Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, China
Shubin Qiao Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, China
Yuejin Yang Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, China
Runlin Gao Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, China
Jinqing Yuan Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, China.
Xueyan Zhao Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, China.

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Neutrophil/HDL-C, Lymphocyte/HDL-C and Monocyte/HDL-C in subjects with asymptomatic carotid atherosclerosis

BACKGROUND

Leukocyte count is a prognostic marker for cardiovascular diseases, with key role in atherosclerosis development. Specific number of neutrophils, lymphocytes and monocytes can predict cardiovascular risk, also in asymptomatic subjects. Among the lipoprotein fractions, HDL-C is a protective factor in the cardiovascular disorders. For the above reason, we have examined the peripheral count of leukocytes, neutrophils, lymphocytes and monocytes, and the ratios between neutrophils/HDL-cholesterol, lymphocytes/HDL-cholesterol, and monocytes/HDL-cholesterol, to evaluate the possible utility of the obtained values in progression of asymptomatic carotid atherosclerosis.

METHODS

We performed our analysis in a cohort of 100 subjects with asymptomatic carotid atherosclerosis, of which 43 men and 57 women. The data were expressed as medians and IQR. To analyse the differences in leukocyte, neutrophil, lymphocyte, monocytes count and their ratio with HDL-cholesterol the Mann-Whitney test was employed.

RESULTS

The peripheral count of leukocyte subtypes and the ratios, they change in relation to the number of cardiovascular risk factors and the degree of insulin resistance.

CONCLUSIONS

In this cohort of subjects, the percentage of observed cardiovascular risk factors significantly affect some leukocyte parameters. These results, allow us to underline the importance of the leukocyte indices in the evaluation of subjects with asymptomatic vascular atherosclerosis.

Association of inflammation and abnormal lipid metabolism with risk of thrombosis and thrombosis progression in patients with polycythemia vera: a retrospective study

To date, no therapeutic strategy has been shown to be effective in reducing the risk of polycythemia vera (PV) transforming into myelofibrosis or leukemia, and the main goal of current treatment is to prevent thrombotic events. Recent studies have shown that higher levels of inflammation are associated with an increased risk of thrombosis in PV patients, while the correlation between inflammation and abnormal lipid metabolism with the risk of thrombosis in PV has not been reported. In this retrospective study, 148 patients with newly diagnosed PV who visited the Affiliated Hospitals of Nanchang University from January 2013 to June 2023 were categorized into low-risk group and high-risk group according to the risk of thrombosis, and were subsequently divided into thrombosis non-progression group and progression group. The differences of novel inflammatory markers PHR, NHR, MHR, LHR, and SIRI in each group were analyzed and compared with healthy adults who underwent physical examination in the hospitals during the same period. The results showed that PHR, NHR, MHR, and SIRI levels were significantly higher in the PV group than in the control group (P < 0.001), while HDL-C levels were considerably lower (1.09 vs. 1.31, P < 0.001). Comparisons within the groups of PV patients revealed that PHR, MHR, NHR, NLR, and SIRI levels were significantly higher in the high-risk group for thrombosis than in the low-risk group (P < 0.01); the thrombosis PHR, NHR, NLR, and SIRI levels were higher in the group with progression of thrombosis than in the group without progression of thrombosis (P < 0.05), while HDL-C levels were significantly lower (1.02 vs. 1.12, P < 0.001). The results of the ROC curve analysis showed that NHR (AUC = 0.791), HDL-C (AUC = 0.691), PHR (AUC = 0.668), NLR(AUC = 0.658), and SIRI (AUC = 0.638) had high diagnostic efficacy for identifying PV patients with thrombosis progression. Multivariate analysis showed that NHR, NLR, MHR, and LHR were independent risk factors for PV patients with thrombosis progression (P < 0.05). Kaplan-Meier survival curves showed that NHR ≥ 5.82 × 109/mmol, NLR ≥ 6.295, PHR ≥ 280.4 × 109/mmol, MHR ≥ 0.295 × 109/mmol, LHR ≥ 1.41 × 109/mmol, and SIRI ≥ 1.53 × 109/L were risk factors for PFS in PV patients. The study demonstrates for the first time that novel inflammatory markers PHR, NHR, MHR, LHR, and SIRI may be used as new predictors for PV patients with thrombosis progression. NHR has the highest value in predicting thrombosis in PV patients and is superior to NLR which was reported previously.

Low lymphocyte to high-density lipoprotein ratio predicts mortality in sepsis patients

Background

The lymphocyte-to-high-density lipoprotein (HDL) ratio (LHR) is associated with both inflammation and immunity, and may have the potential to predict the prognosis of sepsis. Our study aimed to evaluate the relationship between LHR and sepsis-related mortality.

Methods

We collected data from the Medical Information Mart for Intensive Care IV (MIMIC-IV, version 2.2) database by targeting patients who met the Sepsis-3 criteria and recorded the absolute values of lymphocytes and HDL after admission. We then used restricted cubic splines based on logistic regression to simulate the relationship between the LHR and 90-day mortality. Subsequently, the hazardous threshold was derived based on the mortality curve, and further evaluations were performed using different methods and data sources for hazardous threshold.

Results

We ultimately included 1027 eligible patients from the MIMIC-IV database and described the nonlinear relationship between LHR and 90-day mortality. Based on the curve, an LHR of ≤ 0.6 indicated harmful threshold, and the odds ratio for mortality was 1.74 (P=0.001). The outperforming hazard was particularly marked in patients with chronic lung disease and remained consistent after adjusting for baseline data and validating multiple data sources.

Conclusions

The LHR has prognostic value in patients with sepsis, and an LHR ≤ 0.6 is a deleterious load that increases mortality.

Hematological abnormalities and associated factors among metabolic syndrome patients at the University of Gondar comprehensive specialized hospital, Northwest Ethiopia

BACKGROUND

Metabolic Syndrome (MetS) is a cluster of interconnected metabolic diseases. Hematological abnormalities are common but neglected complications of MetS. Thus, this study aimed to determine the magnitude of hematological abnormalities and their associated factors among MetS patients at the University of Gondar comprehensive specialized hospital, Northwest Ethiopia.

METHOD

A hospital-based cross-sectional study was conducted at the University of Gondar comprehensive specialized hospital from March to May 2022. A total of 384 MetS patients were selected using a systematic random sampling technique. Data were collected using pre-tested structured questionnaires and checklists. Anthropometric and blood pressure measurements were taken, and blood sample was collected for complete blood count determination. Stool and blood film examinations were performed to detect intestinal and malaria parasites, respectively. Data were entered into EpiData 3.1 and analyzed by Stata 14.0 software. Bivariate and multivariate logistic regression models were fitted to identify factors associated with hematological abnormalities. A p-value of < 0.05 was considered statistically significant.

RESULTS

The magnitude of anemia, leukopenia, leukocytosis, thrombocytopenia, and thrombocytosis was found to be 13.3%, 0.5%, 2.9%, 1.6%, and 2.3%, respectively. Being male (AOR = 2.65, 95% CI: 1.14, 6.20), rural residency (AOR = 5.79, 95% CI: 1.72, 19.51), taking antihypertensive medications (AOR = 3.85, 95% CI: 1.16, 12.78), having elevated triglyceride level (AOR = 2.21, 95% CI: 1.03, 4.75), and being overweight or obese (AOR = 0.32, 95% CI: 0.16, 0.64) were significantly associated with anemia.

CONCLUSIONS

Anemia was the most prevalent hematological abnormality identified in the present study, followed by leukocytosis and thrombocytosis. Anemia was a mild public health problem among MetS patients in the study area. Routine anemia screening for all MetS patients, especially for those with significant associated factors, may help in the early detection and effective management of anemia, which subsequently improves the patients' quality of life.

Neutrophil-to-high-density-lipoprotein-cholesterol ratio and mortality among patients with hepatocellular carcinoma

Background

Inflammatory responses and lipid metabolism disorders contribute to the development and prognosis of hepatocellular carcinoma (HCC). This study aimed to investigate the prognostic value of lipid-related inflammatory parameters in patients with HCC.

Methods

From January 2010 to June 2017, we enrolled 1,639 patients with HCC at Beijing Ditan Hospital. Multivariate Cox regression analysis and area under the receiver operating characteristic (AUC) analysis were used to evaluate and compare the predictability and reliability of high-density lipoprotein cholesterol (HDL-C), neutrophil-to-HDL-C ratio (NHR), monocyte-to-HDL-C ratio (MHR), and lymphocyte-to-HDL-C ratio (LHR) values. A restricted cubic spline was used to explore the association between the NHR and 3-year mortality in patients with HCC. Differences in survival rates were estimated using the Kaplan-Meier method and compared using the log-rank test. The results were validated in an internal cohort between July 2017 and October 2019 (n = 373).

Results

After adjusting for confounding variables, NHR was independently associated with 3-year mortality, both as a continuous and categorical variable (both p < 0.05). The correlation between the mortality and the MHR and LHR was not statistically significant. The NHR showed a suitable prognostic value (AUC at 3 years: 0.740), similar to that of the Model for End-stage Liver Disease (MELD) (AUC at 3 years: 0.761). In the validation cohort, the AUC of the NHR was 0.734 at 3 years. The optimal cut-off values of NHR and MELD were 3.5 and 9, respectively. The 3-year survival rates in the low- (NHR < 3.5 and MELD <9) and high-risk (NHR ≥ 3.5 and MELD ≥9) groups were 81.8 and 19.4%, respectively, in the training cohort, and 84.6 and 27.5%, respectively, in the validation cohort.

Conclusion

Baseline NHR is a promising prognostic parameter for mortality in patients with HCC and patients with NHR ≥ 3.5 and MELD ≥9 have a high mortality rate.

Taxoids-rich extract from Taxus wallichiana alleviates high-fat diet-induced insulin resistance in C57BL/6 mice through inhibition of low-grade inflammation

The needle powder of Taxus wallichiana is in use for the management of diabetes and inflammation-related complications in the Indian and Chinese Systems of Traditional Medicine but the lack of proper pharmacological intervention has prompted us to investigate the pharmacological mechanism against inflammation-induced insulin resistance in high-fat diet-fed C57BL/6 mice. Hexane (Tw-H), chloroform (Tw-C), and ethyl acetate (Tw-EA) extracts were prepared from a needle of T. wallichiana and its effect on glucose uptake against TNF-α-induced insulin resistance in skeletal muscle cells was studied. Among all, Tw-EA extract has shown promising glucose uptake potential. Tw-EA treatment is also able to decrease the lipid accumulation in adipocytes. Chemical signature of Tw-EA using HPLC showed the presence of taxoids. Efficacy of taxoids-rich extract from T. wallichiana (Tw-EA) was further validated in in vivo system against high-fat diet (HFD)-induced insulin resistance in C57BL/6 mice. Oral treatment of Tw-EA showed significant reduction in blood glucose, pro-inflammatory cytokine production and body weight gain when compared with vehicle-treated HFD-induced insulin resistance in C57BL/6 mice. Histopathology and immunohistochemistry study in skeletal muscle and adipose tissue revealed that oral treatment of Tw-EA is able to reduce the infiltration of inflammatory cells in skeletal muscles, ameliorate the hypertrophy in adipose tissue and upregulate the GLUT4 protein expression. Treatment with Tw-EA significantly up-regulated mRNA expression of insulin signaling pathway (IRS-1, PI3K, AKT, GLUT 4). This study suggested the beneficial effect of taxoids-rich extract from Taxus wallichiana against the inflammation-associated insulin resistance condition.

Correlation of White Blood Cell, Neutrophils, and Hemoglobin with Metabolic Syndrome and Its Components

Background

Metabolic syndrome (MetS) is a global health problem. White blood cell (WBC), neutrophils and neutrophil-to-lymphocyte ratio (NLR) are valid indicators involved in acute and chronic inflammation. The aims of our study were to analyze the correlation and severity of these indicators with MetS and its components, and explore the diagnostic value of their combined tests for MetS.

Methods

A total of 7726 subjects were recruited, and laboratory biomarkers were collected. The differences of indicators between MetS group and non-MetS group were analyzed. The linear trend between each indicator and the increasing number of metabolic disorders was analyzed using trend variance test. The correlation between each indicator and MetS with its components was analyzed by logistic regression.

Results

The levels of WBC, neutrophil, and hemoglobin grew significantly in the MetS group compared to non-MetS group, and gradually increased with the increased number of MetS disorders. Logistic regression analysis indicated significant correlations between WBC, neutrophils, and hemoglobin with MetS and its components. ROC curve analysis showed WBC, neutrophils, and hemoglobin served as good predictors for MetS, especially in adults aged under 40.

Conclusion

Our study indicated that WBC, neutrophils, and hemoglobin are efficient indicators for predicting MetS and evaluate its severity.

Neutrophil-to-lymphocyte, platelet-to-lymphocyte and lymphocyte-to-monocyte ratios, any association with metabolic syndrome?

Background

Metabolic syndrome is a critical health concern associated with an elevated risk of chronic health problems including cardiovascular disease and diabetes. There are shreds of evidence that novel inflammatory ratios including neutrophil-to-lymphocyte, platelet-to-lymphocyte and lymphocyte-to-monocyte ratios serve as prognostic biomarkers for metabolic syndrome (MetS). This hypothesis was investigated in a cohort of the Iranian population.

Methods

selection of MetS + subjects was based on the National Cholesterol Education Program Adult Treatment Panel III criteria 3 (NCEP ATP 3). The control group consisted of participants negative for any of the five MetS criteria. Demographic and laboratory data were extracted from the Tabari cohort study.

Results

A total of 1930 subjects including 965 Mets positive and 965 MetS criteria negative participants were evaluated. Diabetes (84.8%), hypertension (48.9%), hypertriglyceridemia (81.7%), low HDL cholesterol (70.3%), and high waist circumference (78.9%) were observed in patients. There were no differences between NLR (1.66±0.71 vs. 1.69±0.72 P=0.42), LMR (11.23±3.13 vs. 11.30±11.99, P= 0.86) and PLR (113.85±68.67 vs 114.11±35.85, P=0.91) between case and control groups, respectively. Logistic regression analysis revealed no association between ratios and MetS risk even after adjusting for potential confounders including age, gender, living place, and BMI.

Conclusion

In a relatively large population from Northern Iran, no association was observed between CBC-derived inflammatory ratios and the presence of MetS.

Combination model of neutrophil to high-density lipoprotein ratio and system inflammation response index is more valuable for predicting peripheral arterial disease in type 2 diabetic patients: A cross-sectional study

BACKGROUND

Neutrophil/high-density lipoprotein (HDL) ratio (NHR), monocyte/HDL ratio (MHR), lymphocyte/HDL ratio (LHR), platelet/HDL ratio (PHR), systemic immune-inflammation index (SII), system inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI) have been recently investigated as novel inflammatory markers. Herein, the correlation was investigated between these inflammatory biomarkers and peripheral arterial disease (PAD) in type 2 diabetes mellitus (T2DM) patients.

METHODS

In this retrospective observational study, the hematological parameter data of 216 T2DM patients without PAD (T2DM-WPAD) and 218 T2DM patients with PAD (T2DM-PAD) at Fontaine stages II, III or IV stage had been collected. Differences in NHR, MHR, LHR, PHR, SII, SIRI, and AISI were analyzed, and receiver operating characteristic (ROC) curves were used to analyze the diagnostic potential of these parameters.

RESULTS

The levels of NHR, MHR, PHR, SII, SIRI and AISI in T2DM-PAD patients were significantly higher than in T2DM-WPAD patients (P < 0.001). They were correlated with disease severity. Further, multifactorial logistic regression analyses showed that higher NHR, MHR, PHR, SII, SIRI, and AISI might be independent risk factors for T2DM-PAD (P < 0.001). The areas under the curve (AUCs) of the NHR, MHR, PHR, SII, SIRI, and AISI for T2DM-PAD patients was 0.703, 0.685, 0.606, 0.648, 0.711, and 0.670, respectively. The AUC of the NHR and SIRI combined model was 0.733.

CONCLUSION

The levels of NHR, MHR, PHR, SII, SIRI, and AISI were higher in T2DM-PAD patients, and they were independently linked with its clinical severity. The combination model of NHR and SIRI was most valuable for predicting T2DM - PAD.

Leukocyte subtypes, gelatinases, and their tissue inhibitors in a group of subjects with asymptomatic carotid atherosclerosis

In a cohort of subjects with asymptomatic carotid atherosclerosis (ACA), we have evaluated the neutrophil and lymphocyte count and their ratio (NLR), the gelatinases (MMP-2 and MMP-9) and their tissue inhibitors (TIMP-1 and TIMP-2). At baseline, no difference was observed between ACA subjects and subject control group regarding neutrophil and lymphocyte count while was evident in ACA subjects a significant increase in MMP-2, MMP-9 and TIMP-2 associated to a significant decrease in TIMP-1. Dividing the ACA according to the number of cardiovascular risk factors (CRFs) we have observed an increase in lymphocyte count in the subgroup with 3-5 CRFs. Evaluating the leukocyte subtypes according to all the surrogate markers of insulin resistance has been noted, in the subgroups that exceed the medians of these markers, a significant increase in neutrophil and lymphocyte count without any variation of the NLR. Effecting the same evaluation for the MMP/TIMP pattern we observed, instead, that the same subgroups tend to show a decrease in MMP-2 and an increase in MMP-9. No difference instead for TIMP-1 and TIMP-2. The abnormality of the MMP/TIMP pattern, bearing in mind the cardiometabolic clustering present in this cohort of ACA subjects, would induce to use drugs able not only to cure the cardiometabolic risk factors but also to influence the MMP/TIMP profile.

MHR and NHR but not LHR were associated with coronary artery disease in patients with chest pain with controlled LDL-C

Several leukocyte to high-density lipoprotein cholesterol (HDL-C) ratios, including monocyte to HDL-C ratio (MHR), neutrophil to HDL-C ratio (NHR) and lymphocyte to HDL-C ratio (LHR), have been proposed as novel inflammatory indicators. We performed a cross-sectional study to investigate the relationships between these leukocyte to HDL-C ratios and coronary artery disease (CAD) in patients with chest pain with controlled low-density lipoprotein cholesterol (LDL-C). A total of 3482 patients with chest pain with LDL-C <1.8 mmol/L were enrolled. We evaluated the relationships between MHR, NHR, LHR and HDL-C and the occurrence of CAD as well as severe stenosis. We found that in patients with chest pain, higher MHR (adjusted OR=2.83, 95% CI 1.61 to 4.99, p<0.001) and NHR (adjusted OR=1.08, 95% CI 1.04 to 1.13, p<0.001), as well as lower HDL-C (adjusted OR=0.53, 95% CI 0.36 to 0.78, p=0.001), but not higher LHR (adjusted OR=1.06, 95% CI 0.94 to 1.20, p=0.341), had a stronger association with the occurrence of CAD. Moreover, unlike LHR (adjusted OR=1.02, 95% CI 0.93 to 1.13, p=0.654), higher MHR (adjusted OR=2.10, 95% CI 1.43 to 3.07, p<0.001) and NHR (adjusted OR=1.06, 95% CI 1.04 to 1.09, p<0.001) and lower HDL-C (adjusted OR=0.38, 95% CI 0.26 to 0.56, p<0.001) were risk factors for severe stenosis. A receiver operating characteristic curve analysis exhibited comparable abilities between MHR and NHR in predicting the presence and severity of CAD. In conclusion, even though patients with chest pain have achieved LDL-C <1.8 mmol/L, the inflammatory indicators MHR and NHR maintained their predictive abilities and remained associated with the occurrence and severity of CAD.