Impact of monocyte to high-density lipoprotein ratio on the identification of prevalent coronary heart disease: insights from a general population

Figures & data

Figure 1. Flow chart displaying the enrollment of participants

Table 1. Characteristics of subjects divided by CHD

Variables	CHD subjects (n = 202)	non-CHD subjects (n = 6240)	p value*
Age (years)	64.82 ± 8.66	59.40 ± 10.50	<0.001
Females (%)	119 (58.91)	3756 (60.19)	0.714
Education (%)			0.087
Primary school or lower	128 (63.37)	3652 (58.53)
Middle school	48 (23.76)	1924 (30.83)
High school or higher	26 (12.87)	664 (10.64)
Income (CNY, %)			<0.001
≤5000	116 (57.43)	2245 (35.98)
5000–20,000	53 (26.24)	2748 (44.04)
>20,000	33 (16.34)	1247 (19.98)
Frequent exercise (%)	126 (62.38)	5269 (84.44)	<0.001
Current smoking (%)	45 (22.28)	1637 (26.23)	0.208
Current drinking (%)	42 (20.79)	1822 (29.20)	<0.001
Height (cm)	158.83 ± 7.89	158.59 ± 7.97	0.671
Weight (kg)	64.06 ± 11.94	61.84 ± 11.14	0.005
BMI (kg/m*2)	25.33 ± 4.00	24.54 ± 3.77	0.003
WC (cm)	86.31 ± 12.16	82.70 ± 9.87	<0.001
SBP (mmHg)	150.14 ± 23.14	142.09 ± 23.11	<0.001
DBP (mmHg)	90.14 ± 11.69	87.39 ± 11.85	0.001
FPG (mmol/L)	5.88 (5.24–6.79)	5.58 (5.13–6.18)	<0.001
TC (mmol/L)	5.11 ± 1.29	4.98 ± 1.02	0.079
TG (mmol/L)	1.20 (0.88–1.86)	1.20 (0.85–1.75)	0.438
HDL-C (mmol/L)	2.10 ± 0.85	2.33 ± 0.70	<0.001
LDL-C (mmol/L)	1.98 (1.38–2.88)	1.64 (1.33–2.35)	<0.001
WBC count (10*9/L)	6.34 ± 1.76	6.08 ± 1.62	0.026
Neutrophil count (10*9/L)	3.77 ± 1.40	3.62 ± 1.32	0.121
Lymphocyte count (10*9/L)	1.88 ± 0.57	1.83 ± 0.55	0.194
Monocyte count (10*9/L)	0.33 ± 0.11	0.31 ± 0.10	0.004
eGFR (ml/min per 1.73 m*2)	84.93 ± 15.22	92.93 ± 14.04	<0.001
Hypertension (%)	158 (78.22)	3616 (57.95)	<0.001
Anti-HTN therapy (%)	101 (50.00)	1194 (19.13)	<0.001
Diabetes (%)	51 (25.25)	759 (12.16)	<0.001
Lipid lowering medication (%)	21 (10.40)	126 (2.02)	<0.001
Glucocorticoid medication (%)	0 (0.00)	10 (0.16)	0.569
Cerebrovascular disease history (%)	38 (18.81)	400 (6.41)	<0.001
MHR	0.15 (0.11–0.23)	0.13 (0.10–0.17)	<0.001

Data are expressed as median (interquartile range), mean (SD), and numbers (percentage) if appropriate.

Abbreviations: BMI: body mass index; CHD: coronary heart disease; DBP: diastolic blood pressure; CNY: Chinese currency (1CNY = 0.15 USD); eGFR: estimated glomerular filtration rate; FPG: fasting plasma glucose; HDL-C: high-density lipoprotein cholesterol; HTN: hypertension; LDL-C: low-density lipoprotein cholesterol; MHR: monocyte to high-density lipoprotein ratio; SBP: systolic blood pressure; TC: total cholesterol; TG: triglyceride; WBC: white blood cell; WC: waist circumference.

* Chi-square test or rank-sum test were employed to compare categorical variables between groups. Student’s t or Mann–Whitney test were used to compare continuous data between groups.

Table 2. Multivariate logistic regression of MHR for CHD

Variables	Odds Ratio (95% CI)
	Crude	P value	Model 1	P value	Model 2	P value
MHR (Per 1 SD increase)	1.581 (1.377, 1.814)	<0.001	1.556 (1.351, 1.792)	<0.001	1.395 (1.203, 1.619)	<0.001
Quartiles of MHR
Quartile 1	Reference		Reference		Reference
Quartile 2	0.790 (0.485, 1.284)	0.341	0.832 (0.510, 1.359)	0.463	0.825 (0.502, 1.356)	0.448
Quartile 3	1.320 (0.856, 2.035)	0.208	1.371 (0.883, 2.129)	0.160	1.324 (0.844, 2.077)	0.221
Quartile 4	2.372 (1.603, 3.509)	<0.001	2.425 (1.614, 3.644)	<0.001	1.890 (1.225, 2.915)	0.004
P for trend		<0.001		<0.001		<0.001

Crude: no adjustment; Model 1: adjusted for sex, age, exercise, annual family income, education, current smoking, and drinking; Model 2: further adjusted for BMI, WC, hypertension, diabetes, LDL-C, TG, eGFR, lipid-lowering therapy and cerebrovascular disease history.

Abbreviations: BMI: body mass index; CHD: coronary heart disease; CI: confidence interval; eGFR: estimated glomerular filtration rate; LDL-C: low-density lipoprotein cholesterol; MHR: monocyte to high-density lipoprotein ratio; SD: standard deviation; TG: triglyceride; WC: waist circumference.

Quartile 1: 0< MHR<0.100, Quartile 2: 0.100< MHR<0.131, Quartile 3: 0.131< MHR<0.173, Quartile 4: 0.173< MHR.

Figure 2. Smoothing curve fitting of the correlation between MHR and the CHD risk

GAM was employed to plot Smooth curve fitting to investigate the correlation between MHR and the prevalence of CHD after adjusting for sex, age, sex, exercise, education, annual family income, current smoking and drinking, WC, BMI, hypertension, diabetes, LDL-C, TG, eGFR, lipid-lowering therapy and cerebrovascular disease history. In this plot, the solid line indicates the estimated risk of the presence of CHD, and the dotted lines serve as 95% confidence interval. P for non-linear association was conducted by logarithmic likelihood ratio test to compare the one piecewise logistic model with two piecewise logistic models.P for non-linear association indicates the correlation between MHR and the CHD risk followed a linear pattern.

Figure 3. Stratified analyses for the efficacy of MHR on CHD

The logistic model was adjusted for sex, age, exercise, education, annual family income, current smoking and drinking, WC, BMI, hypertension, diabetes, LDL-C, TG, eGFR, lipid-lowering therapy and cerebrovascular disease history apart from the variable that was stratified. None of the stratified variables significantly changed the efficacy of MHR on the CHD risk (all P for interaction >0.05).

Table 3. ROC analysis and reclassification analyses for MHR to advance the risk classification of CHD

Model	AUC (95% CI)	P value	AUC difference	P for comparison	NRI (category free)	P value	IDI	P value
MHR	0.619 (0.607, 0.630)	<0.001	-	-	-	-	-	-
Clinical risk factors *	0.744 (0.733, 0.755)	<0.001	-	-	-	-	-	-
Clinical risk factors + MHR	0.761 (0.750, 0.771)	<0.001	0.017 (0.002, 0.032)	0.028	0.208 (0.069, 0.348)	0.003	0.007 (0.003, 0.012)	0.003

Clinical risk factors: sex, age, current smoking and drinking, WC, BMI, hypertension, diabetes, LDL-C, TG, eGFR, lipid-lowering therapy and cerebrovascular disease history.

Abbreviations: AUC: area under the curve; BMI: body mass index; CHD: coronary heart disease; CI: confidence interval; eGFR: estimated glomerular filtration rate; LDL-C: low-density lipoprotein cholesterol; MHR: monocyte to high-density lipoprotein ratio; ROC: receiver operating characteristic curve; IDI: integrated discrimination index; NRI: net reclassification improvement; TG: triglyceride; WC: waist circumference.