Neutrophil-to-HDL-C Ratio as an inflammatory biomarker in patients with anxiety and obstructive coronary artery disease: A retrospective study

Background Anxiety is a common comorbidity with coronary artery disease (CAD). The neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-high-density lipoprotein cholesterol (HDL-C) ratio (NHR), lymphocyte-to-HDL-C ratio (LHR), and monocytes-to-lymphocyte ratio (MLR) can predict the severity of CAD. This retrospective study aimed to explore the relationship between NLR, NHR, LHR, and MLR and the presence of obstructive or severe CAD (OCAD, SCAD) in patients with comorbid anxiety and chest pain. Methods A total of 1063 patients with anxiety and chest pain were divided into an NOCAD group and OCAD group according to computed topography angiography (CCTA). The 455 patients in the OCAD group were further divided into the NSCAD group (n = 216) and SCAD group (n = 239) according to coronary angiography (CAG) results, and the Gensini score (GS) was calculated. Demographic and laboratory data were collected. Results Multiple regression analysis showed that higher NLR, NHR, and LHR served as independent risk factors for OCAD in patients with anxiety and chest pain (OR 1.37, 95%CI: 1.13–1.65, p = 0.001; OR 2.24, 95%CI: 1.89–2.65, p < 0.001; OR 2.47, 95%CI: 1.87–3.62, p < 0.001), and both were significantly associated with SCAD (OR 1.93, 95%CI: 1.44–2.59, p < 0.001; OR 4.45, 95%CI: 3.28–6.31, p < 0.001; OR 2.86, 95%CI: 1.93–4.25, p < 0.001). Area under the receiver operating characteristic curve analysis showed that NHR had the highest predictive value for OCAD and SCAD compared with NLR and LHR (AUC 0.71, sensitivity 57.14 %, specificity 68.20 %; AUC 0.86, sensitivity 83.68 %, specificity 74.54 %, respectively). When NHR and GS were combined, the predictive value for SCAD further increased compared to other parameters (AUC 0.94, sensitivity 92.05 %, specificity 87.05 %). Conclusion NLR, NHR, and LHR were associated with severity of coronary stenosis in patients with comorbid anxiety and chest pain. Among these systemic inflammatory markers, NHR served as a more effective independent predictor of OCAD and SCAD in these patients.