Neutrophil-to-High-Density Lipoprotein Ratio (NHR) and Neutrophil-to-Lymphocyte Ratio (NLR) as prognostic biomarkers for incident cardiovascular disease and all-cause mortality: A comparison study
Shih‐Ming Chuang, Sung-Chen Liu, Ming-Nan Chien, Chun-Chuan Lee, Yuan-Teh Lee, Kuo‐Liong Chien
Abstract
• The study examines NHR and NLR as biomarkers for predicting cardiovascular disease (CVD) and all-cause mortality. • Both NHR and NLR are effective in identifying high CVD risk, with NHR showing stronger predictive value than NLR or their combination. • NLR alone is a stronger predictor of all-cause mortality than NHR or the combination of NHR and NLR. • The study explores the roles of neutrophils, lymphocytes, and HDL in inflammation, lipid metabolism, and atherosclerosis. • Clinical implications: NHR is a cost-effective tool for CVD risk, while NLR is more relevant for mortality; their combination adds no benefit for CVD or mortality outcomes. Cardiovascular diseases (CVD) remain a leading cause of global mortality, with atherosclerosis and inflammation playing pivotal roles in their development. The neutrophil-to-lymphocyte ratio (NLR) and neutrophil-to-HDL cholesterol ratio (NHR) have emerged as potential biomarkers for assessing CVD risk. In this community-based cohort study conducted in Taiwan, involving 3,278 participants, we investigated the associations between NHR, NLR, and the risks of CVD and all-cause mortality. Our findings revealed that both NHR and NLR were effective in identifying individuals at high risk for CVD. However, when assessing their joint effect, NHR alone demonstrated a stronger predictive value for CVD prognosis than NLR or the combination of both markers. Furthermore, NLR alone showed potential as a predictor of all-cause mortality when compared with NHR alone or in combination with NLR and NHR. These findings underscore the complex interplay between inflammation and lipid metabolism in the pathogenesis of CVD. While NHR shows promise as a cost-effective tool for CVD risk assessment, NLR emerges potential as a prognostic marker for mortality. Further research is warranted to explore the dynamic changes in these markers and their implications for clinical practice.