Key result
Elevated monocyte-to-lymphocyte ratio linked to ~88% greater MACCE risk.
Why the study?
Coronary endothelial dysfunction is an early stage of atherosclerosis, and while inflammation plays a key role in atherosclerotic development, its clinical utility in this initial phase is less clear.
Is elevated monocyte-to-lymphocyte ratio associated with increased risk of major adverse cardiovascular and cerebrovascular events in patients with angina and nonobstructive coronary artery disease?
Cohort (n=892)
No
Is elevated monocyte-to-lymphocyte ratio associated with increased risk of major adverse cardiovascular and cerebrovascular events in patients with angina and nonobstructive coronary artery disease?
Hazard Ratio: 1.88 (95% CI 1.3–2.71)
p-value: p=< 0.001
Elevated monocyte-to-lymphocyte ratio is independently associated with higher MACCE in patients with angina and nonobstructive coronary artery disease, suggesting its potential utility for early-stage atherosclerosis risk assessment.
MLR may refine risk stratification in nonobstructive CAD; hypothesis-generating and requires prospective validation before clinical use.
BACKGROUND: Coronary endothelial dysfunction (CED) is regarded as an early stage of atherosclerosis. Inflammation plays a key role in the mechanism and progression of atherosclerosis, but its clinical utility in the initial phase is less clear. METHODS: Patients with angina and nonobstructive coronary artery disease who underwent coronary reactivity testing at the Mayo Clinic between 1997 and 2021 were enrolled. Endothelium-dependent microvascular dysfunction was a <50 % change in coronary blood flow, and endothelium-dependent epicardial dysfunction was a < -20 % change in epicardial arterial diameter, both with acetylcholine. Endothelium-independent microvascular dysfunction was a coronary flow reserve <2.5 with adenosine, and endothelium-independent epicardial dysfunction was a <20 % change in cross-sectional area after nitroglycerin. Preprocedural monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), and hs-CRP were used for major adverse cardiovascular and cerebrovascular events (MACCE) prediction. RESULTS: In 892 enrolled patients, with a median age of 52[43-61] years, 31 % were male. MLR was significantly higher in patients with endothelium-dependent epicardial (0.281 vs. 0.268, p = 0.042) and microvascular dysfunction (0.280 vs. 0.265, p = 0.015). However, no significant MLR differences were observed in patients with endothelium-independent epicardial or microvascular dysfunction. In a 10-year follow-up, in univariate Cox Regression, higher MLR, NLR and hs-CRP levels were associated with higher MACCE. However, in multivariate Cox Regression for traditional risk factors, only MLR remained a significant independent predictor of MACCE (HR = 1.88, 95 %CI = 1.30-2.71, p < 0.001). CONCLUSIONS: CED is associated with higher levels of MLR. Elevated MLR is independently linked to higher MACCE and may offer potential for early-stage atherosclerosis risk assessment.
No takes yet. Share an insight, caveat, or question.
Kalhor et al. (2025) conducted a cohort in angina and nonobstructive coronary artery disease (n=892). Elevated monocyte-to-lymphocyte ratio (MLR) vs. Lower MLR was evaluated on major adverse cardiovascular and cerebrovascular events (MACCE) (HR 1.88, 95% CI 1.30-2.71, p=< 0.001). Elevated monocyte-to-lymphocyte ratio was independently associated with a higher risk of major adverse cardiovascular and cerebrovascular events (HR 1.88; 95% CI 1.30-2.71; p<0.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: