The Monocyte to High-Density Lipoprotein Cholesterol Ratio in the Prediction for Atherosclerosis: A Retrospective Study in Adult Chinese Participants

Assessing the relationship between monocyte-to-HDL cholesterol ratio and mortality in patients with hypertrophic cardiomyopathy

OBJECTIVE

A new inflammatory marker, namely monocyte-to-high-density lipoprotein cholesterol ratio (MHR), has emerged as a useful indicator for adverse outcomes in several cardiovascular diseases; however, the relationship between MHR and the prognosis of hypertrophic cardiomyopathy (HCM) remains to be evaluated. We examined the relationship between MHR and all-cause mortality (ACM) in Chinese adult patients with HCM.

METHODS

We retrospectively performed clinical evaluation in 305 patients with HCM (median age: 52.0 years, male: 54.10%).

RESULTS

During a median follow-up of 4.9 years, ACM occurred in 57 (18.7%) patients. Based on the tertiles of baseline MHR, ACM increased with higher tertile. With tertile 1 as reference, adjusted ACM hazard ratios (HRs) were 2.68 for tertile 2 (95% confidence interval [CI]: 1.18-6.11, p = 0.019) and 4.85 for tertile 3 (95% CI: 2.16-10.89, p < 0.001). Stratified analysis and E-value analysis suggested the robustness of the above-mentioned results. Furthermore, adjusted smooth curve fitting exhibited a non-linear relationship between MHR and ACM (inflection point: 0.5), and the risk of ACM increased significantly with higher MHR only the value below the inflection point (HR: 4.37 per one standard deviation, 95% CI: 1.81-10.6, p = 0.001). Finally, sensitivity analysis was similar to the main findings.

CONCLUSION

In Chinese adult patients with HCM, higher MHR is a strong independent predictor of ACM, and a non-linear relationship is also observed between MHR and ACM.

Serum levels of sonic hedgehog in patients with IgA nephropathy are closely associated with intrarenal arteriolar lesions

BACKGROUND

Intrarenal arteriolar disease is a major risk factor for poor prognosis in immunoglobulin A nephropathy (IgAN). The morphologic factor sonic hedgehog (SHH) plays an important role in a variety of vascular diseases, so it may be directly or indirectly involved in the process of renal arteriolar disease. The purpose of this study was to investigate the correlation between serum SHH levels and renal arteriole disease in patients with IgAN.

METHODS

Subjects with primary IgAN diagnosed by renal biopsy performed between October 2018 and August 2019 at the First Medical Center of the Chinese PLA General Hospital were recruited. Blood specimens were collected from the patients within 1 week before renal biopsy after they signed an informed consent form, and healthy controls were recruited for blood specimen collection during the same period. The concentration of serum SHH was measured by enzyme-linked immunosorbent assay in this population.

RESULTS

Serum SHH levels were significantly lower in the IgAN group than in the control group. 41 of the 94 subjects diagnosed with IgAN had severe renal arteriolosclerosis and, compared to their less severely affected counterparts, were older, more hypertensive, and characterized by lower levels of SHH, higher levels of tubular atrophy/interstitial fibrosis and a higher Lee's classification. Serum SHH concentration was found to be an independent predictor of severe intrarenal arteriolosclerosis in IgAN subjects after correction using multivariate analysis.

CONCLUSION

In this study, serum SHH levels were found to be significantly lower in patients with IgAN than in healthy subjects. Serum SHH may serve as a noninvasive biomarker of intrarenal arteriolosclerosis in patients with IgAN.

The correlation between visceral fat/subcutaneous fat area ratio and monocyte/high-density lipoprotein ratio in patients with type 2 diabetes mellitus and albuminuria

OBJECTIVE

This study aims to observe the correlation between the visceral fat/subcutaneous fat area ratio (VSR) and peripheral blood monocyte/high-density lipoprotein ratio (MHR) in patients with type 2 diabetes mellitus (T2DM) and albuminuria.

METHODS

Based on the urinary albumin/creatinine ratio (UACR), 89 T2DM patients were divided into normo-albuminuria group (n = 49, UACR <30 mg/g) and albuminuria group (n = 40, UACR ≥30 mg/g). Gender, age, body mass index (BMI), duration of T2DM, blood pressure, visceral fat area (VA), subcutaneous fat area (SA), biochemical indexes of blood serum and urinary were collected and compared between the two groups, and the relationship between VSR and MHR was analyzed in albuminuria group.

RESULTS

No significant differences existed in gender, age, BMI, duration of diabetes, blood pressure, serum lipids, and hemoglobin Alc between the two groups. The levels of VA, VSR, MHR, and UACR were higher in the albuminuria group (P < 0.05). VSR was positively correlated with MHR (r = 0.39, P < 0.01), whereas VA was not significantly correlated with MHR in the albuminuria group.

CONCLUSION

Compared with VA, VSR was significantly correlated with MHR, suggesting that VSR is more closely related to the occurrence of chronic inflammation in type 2 diabetics with albuminuria.

Which Biomarker(s) Augment the Diagnostic Value of the Positive Exercise Electrocardiography Test: Systemic Inflammatory Index, Plasma Atherogenic Index, or Monocyte/HDL-C Ratio?

The exercise electrocardiography test (EET) is still used before coronary angiography in the diagnosis of chronic coronary syndromes. This study aimed to demonstrate the value of the combination of a positive EET with the systemic inflammatory index (SII), the plasma atherogenic index (PAI), and the monocyte/HDL-C ratio (MHR) in the determination of obstructive coronary artery disease (CAD). This single-center, retrospective study included 540 patients who underwent coronary angiography after ETT. The patients were separated into Group 1, comprising 434 patients with normal coronary arteries and non-obstructive CAD, and Group 2, including 106 with obstructive CAD. In Group 2, the patients were separated into SYNTAX ≤ 22 or ≥23. Glucose, low-density lipoprotein, white blood cells, and MHR were determined to be significantly higher in Group 2 (p < 0.05). According to the multivariate logistic regression analysis, age, gender, diabetes mellitus, and low-density lipoprotein were determined to be independent predictors of CAD. In the ROC curve analysis, a cut-off value of 12 for the MHR in the determination of obstructive CAD had a sensitivity of 60.4% and a specificity of 53.0%. The main result of this study was that a high MHR is an indicator of obstructive CAD in patients with positive EET and suspected CAD.

Monocyte to high-density lipoprotein ratio is associated with mortality in patients with coronary artery diseases

BACKGROUND

Whether the monocyte to high-density lipoprotein ratio (MHR) is associated with the prognosis of coronary artery disease (CAD) is inconclusive.

METHODS

Patients with CAD were enrolled and their data were collected. Blood was sampled within 24 h after admission. Multivariate Cox regression analysis was performed to determine the relationship between the MHR and all-cause mortality as well as complications during hospitalization.

RESULTS

We included 5371 patients in our cohort study. Among them, 114 (2.12%) patients died in hospital. MHR was independently associated with all-cause mortality (hazard ratio [HR], 1.81; 95% confidence interval [CI] 1.35, 2.42), cardiovascular mortality (1.69; 1.17, 2.45) and non-cardiovascular mortality (2.04; 1.27, 3.28). This association was only observed in patients with hypertension (P for interaction = 0.003). Patients with higher MHR levels also have a higher risk of complications, including infection, pneumonia, electrolyte disturbance, gastrointestinal bleeding, multiple organ dysfunction syndrome, and disturbance of consciousness. The receiver operating characteristic (ROC) analysis showed that the MHR had higher prognostic values than monocytes and high-density lipoprotein.

CONCLUSION

MHR was an independent predictor of all-cause mortality and in-hospital complications in patients with CAD, especially in patients with hypertension.

Evaluation of frontal QRS-T angle values in electrocardiography in patients with chronic rhinosinusitis

BACKGROUND

Chronic Rhinosinusitis (CRS) refers to inflammation of the paranasal sinuses and nasal mucosa. Electrocardiographic indicators of ventricular repolarization have been shown to correlate with systemic inflammation parameters. Recently, the frontal QRS-T (fQRS-T) angle has been accepted as a new indicator of ventricular depolarization and repolarization heterogeneity. The (fQRS-T) angle is recommended in predicting the risk of malignant ventricular arrhythmia. In this study, we aimed to evaluate the ventricular arrhythmia potential in patients with chronic rhinosinusitis by examining the relationship between fQRS-T angle on ECG and inflammation markers.

METHODS

Inflammatory markers as well as electrocardiographc (ECG) f(QRS-T) angle, QRS duration, QT interval and corrected QT interval were examined in 54 patients with CRS versus 56 healthy control subjects.

RESULTS

The f(QRS-T) angle was significantly higher in CRS patients than in healthy controls (p < .001). The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and monocyte-to-lymphocyte ratio (MLR) were significantly higher in CRS patients compared to healthy controls (p < .001, for all). Based on correlation analysis, NLR and f(QRS-T) angles were highly correlated (r = .845, p < .001), and according to the results of linear regression analysis, NLR was independently associated with the f(QRS-T) angle (t = 5.149, Beta = 0.595, p = < 0.001).

CONCLUSION

Both f(QRS-T) angle and NLR are significantly increased in CRS patients compared to healthy controls, with increases in NLR also independently associating with increases in f(QRS-T) angle. While the increases in f(QRS-T) angle did not result in clinically alarming absolute values for f(QRS-T), CRS patients might nonetheless be at relatively higher risk for malignant cardiac arrhythmias.

Association between monocyte to high-density lipoprotein ratio and coronary heart disease in US adults in the National Health and Nutrition Examination Surveys 2009-2018

BACKGROUND

Monocyte to high-density lipoprotein ratio (MHR) is associated with coronary heart disease (CHD) events. The purpose of this study was to analyze the correlation between MHR and CHD in American adults from 2009 to 2018 in the National Health and Nutrition Examination Surveys (NHANES) database.

METHODS

A total of 25 862 persons in the NHANES from 2009 to 2018 were included in the cross-sectional analysis. The independent variable was MHR and the outcome variable was CHD. MHR was obtained by dividing the number of monocytes by the high-density lipoprotein concentration, and whether it is CHD is obtained through a questionnaire. Univariate analysis, stratified analysis, and a multivariate linear regression model were used to study the correlation between MHR and CHD.

RESULTS

In each multivariate linear regression model, MHR was positively correlated with CHD, and this positive correlation was stable in both men and women [man odds ratio (OR): 1.54; 95% confidence interval (CI), 1.17-2.03; woman OR: 2.21; 95% CI, 1.40-3.50]. Our results show that the association between MHR and CHD was significant until MHR was less than 0.6 (OR: 7.2; 95% CI, 4.0-13.0); however, in cases where MHR was greater than 0.6, the results were negative but not significantly different (OR: 0.6; 95% CI, 0.3-1.2).

CONCLUSION

MHR has a clear association with CHD. Our prediction model and validation model show that MHR is highly predictive and robust as a predictor of CHD, therefore it can play an important role in the prediction of CHD.

Monocyte to high-density lipoprotein ratio presents a linear association with atherosclerosis and nonlinear association with arteriosclerosis in elderly Chinese population: The Northern Shanghai Study

BACKGROUND AND AIMS

Inflammation closely correlates with atherosclerosis and cardiovascular disease (CVD). Monocyte to high-density lipoprotein cholesterol ratio (MHR) is a novel inflammation index that can be obtained by routine blood tests. We aimed to investigate the associations between MHR and atherosclerosis and arteriosclerosis.

METHODS AND RESULTS

We enrolled 2451 participants from the Northern Shanghai Study. Atherosclerosis (carotid plaque (CP), lower extremity atherosclerotic (LEA) assessed by ankle-brachial index) and arteriosclerosis (arterial stiffness (AS) assessed by carotid-femoral pulse wave velocity) were measured using standard methods. In the univariable logistic regression model, higher MHR was significantly associated with increased AS, CP, and LEA risk. In the multivariable logistic regression model, after adjustment for age, sex, hypertension, diabetes mellitus, body mass index, smoking habit, low-density lipoprotein cholesterol, and family history of premature CVD, quartile 4 (Q4) of MHR was associated with an increased risk of AS (odds ratio (OR) = 1.41; 95% confidence interval (CI):1.05-1.88; P _fortrend = 0.036), CP (OR = 1.35; 95%CI:1.04-1.77; P _{for trend} = 0.044), and LEA (OR = 2.23; 95%CI:1.49-3.35; P _{for trend}< 0.001). Similar results were observed when MHR was analyzed as a continuous variable. The restricted cubic spline (RCS) curve showed that the association between MHR and AS was nonlinear (P _nonlinear = 0.021), but not LEA (P _nonlinear = 0.177) or CP (P _nonlinear = 0.72).

CONCLUSION

MHR presents a linear association with atherosclerosis and a nonlinear association with arteriosclerosis in the elderly Chinese population. These findings may indicate the need for early assessment and intervention for inflammation. The registration number for clinical trials: NCT02368938.

Association of the Monocyte-to-High-Density Lipoprotein Cholesterol Ratio with Gastrointestinal Involvement of Immunoglobulin a Vasculitis

Objective

To illustrate the association of monocyte to high-density lipoprotein cholesterol ratio (MHR) and other serum indicators with the pathogenesis and prognosis of immunoglobulin A vasculitis (IgAV) patients in different subgroups.

Methods

A total of 158 adult patients and 113 healthy controls were enrolled, and the clinical presentation and laboratory indexes were comprehensively assessed.

Results

IgAV patients show significantly elevated levels of inflammatory parameters and lipid profiles compared to healthy controls (P < 0.05). Higher levels of the MHR and other normal inflammatory indicators were found in patients with Gastrointestinal (GI) involvement compared to other subgroups. And in group with GI involvement, significantly higher white blood cell (WBC), neutrophil, complement 4 (C4), NLR (neutrophil-to-lymphocyte ratio) and PLR (platelet-to-lymphocyte ratio) levels and lower levels of apolipoprotein-a (Apo-a) were observed. Their correlation analysis demonstrated positive results between MHR level and white blood cell (WBC) count (r = 0.416, P = 0.034), D-Dimer (r = 0.464, P = 0.026) and monocyte (r = 0.947, P < 0.001). And the time until first remission of skin purpura was shown positively correlated with their age (r = 0.456, P = 0.043), C-reactive protein (CRP) level (r = 0.641, P = 0.018), D-Dimer level (r = 0.502, P = 0.040) while negatively correlated with albumin (Alb) level (r=-0.626, P = 0.003) and low-density lipoprotein (LDL) level (r=-0.478, P = 0.033).

Conclusion

Our study suggests that those biomarkers represented for inflammatory responses, lipid profile and immunological functions have significant differences in the subgroups of adult IgAV patients. In addition, we also found that MHR level may serve as a potential biomarker for the pathogenesis and prognosis of IgAV patients with GI involvement.

A scoring system developed from a nomogram to differentiate active pulmonary tuberculosis from inactive pulmonary tuberculosis

Purpose

This study aimed to develop and validate a scoring system based on a nomogram of common clinical metrics to discriminate between active pulmonary tuberculosis (APTB) and inactive pulmonary tuberculosis (IPTB).

Patients and methods

A total of 1096 patients with pulmonary tuberculosis (PTB) admitted to Wuhan Jinyintan Hospital between January 2017 and December 2019 were included in this study. Of these patients with PTB, 744 were included in the training cohort (70%; 458 patients with APTB, and 286 patients with IPTB), and 352 were included in the validation cohort (30%; 220 patients with APTB, and 132 patients with IPTB). Data from 744 patients from the training cohort were used to establish the diagnostic model. Routine blood examination indices and biochemical indicators were collected to construct a diagnostic model using the nomogram, which was then transformed into a scoring system. Furthermore, data from 352 patients from the validation cohort were used to validate the scoring system.

Results

Six variables were selected to construct the prediction model. In the scoring system, the mean corpuscular volume, erythrocyte sedimentation rate, albumin level, adenosine deaminase level, monocyte-to-high-density lipoprotein ratio, and high-sensitivity C-reactive protein-to-lymphocyte ratio were 6, 4, 7, 5, 5, and 10, respectively. When the cut-off value was 15.5, the scoring system for recognizing APTB and IPTB exhibited excellent diagnostic performance. The area under the curve, specificity, and sensitivity of the training cohort were 0.919, 84.06%, and 86.36%, respectively, whereas those of the validation cohort were 0.900, 82.73, and 86.36%, respectively.

Conclusion

This study successfully constructed a scoring system for distinguishing APTB from IPTB that performed well.

Association of Increased Pulse Wave Velocity With Long-Term Clinical Outcomes in Patients With Preserved Ankle-Brachial Index After Acute Myocardial Infarction

BACKGROUND

Low ankle-brachial index (ABI) is an established risk factor for long-term cardiovascular outcomes in patients with acute myocardial infarction (AMI), and brachial-ankle pulse wave velocity (ba-PWV) may also be a risk factor. However, there is a significant overlap between low ABI and high ba-PWV. The purpose of this retrospective study was to examine whether increased ba-PWV was associated with long-term clinical outcomes in AMI patients with normal ABI.

METHODS

We included 932 AMI patients with normal ABI and divided them into the high PWV group (≥1,400 cm/s; n=646) and the low PWV group (<1400 cm/s; n=286) according to the ba-PWV values measured during the AMI hospitalisation. The primary endpoint was the major adverse cardiovascular events (MACE) defined as the composite of all-cause death, nonfatal myocardial infarction, and hospitalisation for heart failure.

RESULTS

During the median follow-up duration of 541 days (Q1: 215 days-Q3: 1,022 days), a total of 154 MACE were observed. The Kaplan-Meier curves showed that MACE was more frequently observed in the high PWV group than in the low PWV group (p<0.001). The multivariate Cox hazard analysis revealed that high ba-PWV was significantly associated with MACE (hazard ratio [HR] 1.587; 95% CI 1.002-2.513; p=0.049) after controlling multiple confounding factors.

CONCLUSIONS

High ba-PWV was significantly associated with long-term adverse events in AMI patients with normal ABI. Our results suggest the usefulness of PWV as a prognostic marker in AMI with normal ABI.

Effect of PCSK9 inhibitors on pulse wave velocity and monocyte-to-HDL-cholesterol ratio in familial hypercholesterolemia subjects: results from a single-lipid-unit real-life setting

AIMS

Subjects with familial hypercholesterolemia (FH) are characterized by an increased amount of low-density lipoprotein cholesterol (LDL-C) that promotes a continuous inflammatory stimulus. Our aim was to evaluate the effect of PCSK9-i on inflammatory biomarkers, neutrophil-to-lymphocyte ratio, monocyte-to-high-density lipoprotein ratio (MHR), and on early atherosclerosis damage analyzed by pulse wave velocity (PWV) in a cohort of FH subjects.

METHODS

In this prospective observational study, we evaluated 56 FH subjects on high-intensity statins plus ezetimibe and with an off-target LDL-C. All subjects were placed on PCSK9-i therapy and obtained biochemical analysis as well as PWV evaluation at baseline and after six months of PCSK9-i therapy.

RESULTS

After six months of add-on PCSK9-i therapy, only 42.9% of FH subjects attained LDL-C targets. As expected, a significant reduction of LDL-C (- 49.61%, p < 0.001) was observed after PCSK9-i therapy. Neutrophil count (NC) and MHR were reduced by PCSK9-i (-13.82% and -10.47%, respectively, p value for both < 0.05) and PWV significantly decreased after PCSK9-i therapy (- 20.4%, p < 0.05). Finally, simple regression analyses showed that ∆ PWV was significantly associated with ∆ LDL-C (p < 0.01), ∆ NC and ∆ MHR (p value for both < 0.05).

CONCLUSIONS

In conclusion, PCSK9-i therapy significantly improved lipid and inflammatory profiles and PWV values in FH subjects; our results support the positive effect of PCSK9-i in clinical practice.