Key result
Higher ANLR linked to ~12% lower all-cause mortality in ASCVD patients.
Why the study?
Serum albumin and neutrophil-to-lymphocyte ratio are linked to adverse cardiovascular outcomes, but few studies have used the albumin-to-neutrophil-lymphocyte ratio to assess mortality risk in atherosclerotic cardiovascular disease.
Is the serum albumin to neutrophil-to-lymphocyte ratio (ANLR) associated with all-cause and cardiovascular mortality in patients with atherosclerotic cardiovascular disease?
Cohort (n=2,918)
Is the serum albumin to neutrophil-to-lymphocyte ratio (ANLR) associated with all-cause and cardiovascular mortality in patients with atherosclerotic cardiovascular disease?
The albumin-to-neutrophil-lymphocyte ratio (ANLR) is inversely and nonlinearly associated with all-cause and cardiovascular mortality in ASCVD patients, offering an economical prognostic biomarker with a practical high-risk threshold below 1.8.
Answers are grounded in this paper and cite their sources.
Should not yet guide risk stratification in atherosclerotic disease; hypothesis-generating and requires prospective validation.
BackgroundSerum albumin (ALB) and neutrophil-to-lymphocyte ratio (NLR) are linked to adverse cardiovascular outcomes, but few studies have used ALB/NLR (ANLR) to assess mortality risk in atherosclerotic cardiovascular disease (ASCVD). This study evaluated the nonlinear association between ANLR and all-cause mortality (ACM) and cardiovascular mortality (CVM) in ASCVD patients.MethodsThis study was grounded in data from the National Health and Nutrition Examination Survey spanning 1999 to 2018.ResultsThe study cohort comprised 2,918 participants. During the follow-up period, 1,231 all-cause deaths and 454 cardiovascular deaths occurred. Kaplan-Meier survival analysis showed that a lower ANLR (Q1) was associated with worse survival outcomes (ACM and CVM: log-rank test P < 0.001). Multivariate Cox regression showed a significant inverse association between ANLR and the risk of ACM (hazard ratio [HR] = 0.883, 95% confidence interval [CI]: 0.810-0.964, P = 0.005). After ANLR was grouped according to quartiles, the risk of CVM in the Q2-Q4 groups was significantly lower than that in the Q1 group. Restricted cubic spline analysis further revealed a nonlinear negative link between ANLR and the risk of ACM (P for nonlinear < 0.001), and the risk rose sharply when ANLR < 1.8, suggesting this value may be a practical cutoff for identifying high-risk individuals. Additionally, the elevated risk observed at ANLR > 3.816 may reflect a U-shaped association rather than measurement error alone.ConclusionsANLR was significantly and negatively associated with the risk of ACM and CVM in ASCVD, and there was a nonlinear threshold effect. This finding provides an economical biomarker for identifying high-risk individuals and assessing the prognosis of ASCVD. Nonetheless, longitudinal studies are needed to verify these findings.
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Ye et al. (2026) conducted a cohort in Atherosclerotic cardiovascular disease (ASCVD) (n=2,918). Albumin/neutrophil-to-lymphocyte ratio (ANLR) vs. Lowest ANLR quartile (Q1) or lower ANLR levels was evaluated on All-cause mortality (ACM) and cardiovascular mortality (CVM) (HR 0.883, 95% CI 0.810-0.964, p=0.005). Higher albumin/neutrophil-to-lymphocyte ratio (ANLR) was inversely associated with all-cause mortality in ASCVD patients (HR 0.883, 95% CI 0.810-0.964; P=0.005), with risk rising sharply at ANLR <1.8.
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