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

Rengui Jiang; Huangtao Ruan; Wanying Wu; Yueting Wang; Haozhang Huang; Xiaozhao Lu; Weipeng Liang; Yang Zhou; Jielan Wu; Xianlin Ruan; Jinming Chen; Weipeng Zhang; Yulong Xiang; Zhitao Yan; Yong Liu; Ning Tan

doi:10.1016/j.jacl.2024.08.005

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

J Clin Lipidol. 2024 Aug 30:S1933-2874(24)00232-0. doi: 10.1016/j.jacl.2024.08.005. Online ahead of print.

Authors

Rengui Jiang¹, Huangtao Ruan², Wanying Wu², Yueting Wang³, Haozhang Huang⁴, Xiaozhao Lu⁴, Weipeng Liang⁵, Yang Zhou⁴, Jielan Wu⁴, Xianlin Ruan⁴, Jinming Chen⁴, Weipeng Zhang⁶, Yulong Xiang⁶, Zhitao Yan³, Yong Liu⁷, Ning Tan⁴

Affiliations

¹ Department of Cardiology, Ganzhou Hospital of Guangdong Provincial People's Hospital, Ganzhou Municipal Hospital (Gannan Medical University Affiliated Municipal Hospital), Ganzhou 341000, China (Drs Jiang, Wang, Yan); Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510515, China (Drs Jiang, Huang, Lu, Liang, Zhou, Wu, Ruan, Chen, Liu, Tan); Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China (Drs Jiang, Ruan, Wu, Huang, Lu, Zhou, Wu, Ruan, Chen, Liu, Tan).
² Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China (Drs Jiang, Ruan, Wu, Huang, Lu, Zhou, Wu, Ruan, Chen, Liu, Tan).
³ Department of Cardiology, Ganzhou Hospital of Guangdong Provincial People's Hospital, Ganzhou Municipal Hospital (Gannan Medical University Affiliated Municipal Hospital), Ganzhou 341000, China (Drs Jiang, Wang, Yan).
⁴ Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510515, China (Drs Jiang, Huang, Lu, Liang, Zhou, Wu, Ruan, Chen, Liu, Tan); Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China (Drs Jiang, Ruan, Wu, Huang, Lu, Zhou, Wu, Ruan, Chen, Liu, Tan).
⁵ Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510515, China (Drs Jiang, Huang, Lu, Liang, Zhou, Wu, Ruan, Chen, Liu, Tan).
⁶ School of Medicine South China University of Technology, Guangzhou 510100, China (Drs Zhang, Xiang); Guangdong Provincial People's Hospital, (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510515, China (Drs Zhang, Xiang).
⁷ Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510515, China (Drs Jiang, Huang, Lu, Liang, Zhou, Wu, Ruan, Chen, Liu, Tan); Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China (Drs Jiang, Ruan, Wu, Huang, Lu, Zhou, Wu, Ruan, Chen, Liu, Tan). Electronic address: liuyong@gdph.org.cn.

PMID: 39306543
DOI: 10.1016/j.jacl.2024.08.005

Abstract

Background and aims: The monocyte/lymphocyte ratio (MLR), an inflammatory marker, has an unclear relationship with the risk of residual inflammation in patients with coronary artery disease (CAD) and low-density lipoprotein cholesterol (LDL-C) below 1.4 mmol/L. This study aimed to assess the association between the MLR and cardiovascular and all-cause mortalities in these patients.

Methods: A total of 2747 patients diagnosed with CAD via coronary angiography (CAG) and presenting with LDL-C levels < 1.4 mmol/L were enrolled in this observational study conducted from January 2007 to December 2020. Patients were categorized into four groups based on the MLR quartiles. We used Kaplan-Meier analysis and Cox regression models to evaluate the relationship between baseline MLR and cardiovascular and all-cause mortalities.

Results: Among the 2747 participants followed up for a median duration of 6 years, there were 184 cardiovascular and 462 all-cause deaths. Elevated MLR levels were found to be associated with an increased risk of both cardiovascular and all-cause mortalities according to the Kaplan-Meier analysis. Multivariate Cox regression analysis demonstrated a significant association between higher MLR and an elevated risk of cardiovascular and all-cause mortality. Compared to the older group, with an increase in MLR levels, the younger group showed a higher hazard ratio for cardiovascular death. Similar results were obtained in the single-vessel disease group.

Conclusions: In patients with CAD and LDL-C levels < 1.4 mmol/L, MLR can serve as a risk factor for both cardiovascular and all-cause mortalities owing to the risk of residual inflammation.

Keywords: Cardiovascular mortality; Coronary artery disease; Low-density lipoprotein cholesterol; Monocyte/lymphocyte ratio.