Is monocyte to HDL ratio superior to monocyte count in predicting the cardiovascular outcomes: evidence from a large cohort of Chinese patients undergoing coronary angiography

Figures & data

Figure 1. The levels of MHR (A), MC (B), and Gensini score (C) in patients with or without MACEs and the levels of Gensini score by MHR (D) or MC (E) tertiles.

Table 1. Baseline and demographical characteristics of the study population.

	Total (n = 3630)	Events (n = 347)	No events (n = 3283)	p value
Demographic characteristics
Age (years)	57.9 ± 9.9	59.4 ± 9.9	57.8 ± 9.9	0.005
Male sex, n (%)	2556 (70.4)	251 (72.3)	2303 (70.1)	0.422
Body mass index, (kg/m^2)	25.7 ± 3.2	25.7 ± 3.1	25.7 ± 3.2	0.639
Smoker, n (%)	1906 (52.5)	186 (53.6)	1720 (52.4)	0.692
Hypertension, n (%)	2261 (62.3)	252 (72.5)	2009 (61.2)	<0.001
Diabetes mellitus, n (%)	951 (26.2)	114 (32.8)	837 (25.5)	0.005
Dyslipidemia, n (%)	2701 (74.4)	270 (77.9)	2429 (74.0)	0.135
Family history of CAD, n (%)	570 (15.7)	51 (14.7)	519 (15.8)	0.777
Treatment strategies, n (%)				<0.001
PCI	1761 (48.5)	197 (11.2)	1564 (88.8)
CABG	163 (4.5)	28 (17.0)	135 (83.0)
Medicine management	1706 (47.0)	121 (7.1)	1585 (92.9)
Prior medication, n (%)
ACEI	410 (11.3)	50 (14.7)	361 (11.0)	0.224
ARB	457 (12.6)	54 (15.5)	407 (12.4)	0.311
β-blockers	1848 (50.9)	181 (52.1)	1668 (50.8)	0.848
Statins	2410 (66.4)	220 (63.4)	2190 (66.7)	0.319
Laboratory parameters
WBC count (×10^9/L)	6.30 ± 1.64	6.55 ± 1.78	6.27 ± 1.62	0.002
Neutrophil count (×10^9/L)	3.79 ± 1.29	3.97 ± 1.42	3.77 ± 1.27	0.004
Lymphocyte count (×10^9/L)	1.90 ± 0.62	1.90 ± 0.62	1.90 ± 0.62	0.818
MC (×10^9/L)	0.43 ± 0.16	0.47 ± 0.18	0.42 ± 0.15	<0.001
hs-CRP (mg/L)	1.46 (0.75–2.90)	1.67 (0.89–3.14)	1.42 (0.73–2.87)	0.008
TC (mmol/L)	4.20 ± 1.11	4.25 ± 1.14	4.19 ± 1.11	0.372
TG (mmol/L)	1.52 (1.11–2.11)	1.56 (1.15–2.15)	1.51 (1.11–2.10)	0.291
LDL-C (mmol/L)	2.53 ± 0.96	2.53 ± 0.91	2.53 ± 0.97	0.969
HDL-C (mmol/L)	1.08 ± 0.28	1.07 ± 0.28	1.08 ± 0.29	0.477
Monocyte to HDL-C ratio	0.39 (0.29–0.53)	0.43 (0.30–0.57)	0.39 (0.29–0.52)	<0.001

Data are expressed as mean (SD), median (IQR) or n (%). Bold values indicate statistical significance. CAD: coronary artery disease; PCI: percutaneous coronary intervention; CABG: coronary artery bypass grafting; ACEI: angiotensin converting enzyme inhibitors; ARB: angiotensin receptor blocker; WBC: white blood cell; hs-CRP: high-sensitivity C-reactive protein; TC: total cholesterol; TG: triglyceride; LDL-C: low density lipoprotein cholesterol; HDL-C: high density lipoprotein cholesterol.

Figure 2. The number of traditional cardiovascular risk factors by monocyte (A) or MHR (B) tertiles.

Table 2. Relationship of MHR or MC with cardiovascular characteristics.

	Tertile 1	Tertile 2	Tertile 3	p value
	Low MC (n = 1367)	Medium MC (n = 1227)	High MC (n = 1204)
Traditional parameters
Hs-CRP	1.12 (0.58–2.24)	1.48 (0.76–2.87)	1.99 (0.99–4.23)	<0.001
LVEDD	47.6 ± 5.1	48.4 ± 5.0	48.2 ± 5.5	0.001
LVEF	64.2 ± 7.1	63.5 ± 7.8	62.8 ± 8.1	<0.001
Angiographic characteristics
Angiography proven CAD, n (%)	1152 (84.3)	1075 (87.6)	1079 (89.6)	<0.001
LM diseased, n (%)	100 (7.3)	106 (8.6)	135 (11.2)	0.003
1 vessel diseased, n (%)	354 (25.9)	318 (25.9)	301 (25.0)	0.846
2 vessels diseased, n (%)	388 (28.4)	346 (28.2)	341 (28.3)	0.989
Multi-vessels diseased, n (%)	399 (29.2)	405 (33.0)	427 (35.5)	0.003
Gensini score	18 (5–39)	20 (6–44)	23 (8–49)	<0.001
MACEs, n (%)	104 (7.6)	99 (8.1)	144 (12.0)	<0.001
	Tertile 1	Tertile 2	Tertile 3	p value
	Low MHR (n = 1266)	Medium MHR (n = 1268)	High MHR (n = 1264)
Traditional parameters
Hs-CRP	1.07 (0.54–2.10)	1.42 (0.76–2.75)	2.03 (1.05–4.28)	<0.001
LVEDD	47.2 ± 5.1	48.4 ± 5.0	48.6 ± 5.3	<0.001
LVEF	64.3 ± 7.1	63.5 ± 7.6	62.8 ± 8.3	<0.001
Angiographic characteristics
Angiography proven CAD, n (%)	1046 (82.6)	1113 (87.8)	1147 (90.7)	<0.001
LM diseased, n (%)	81 (6.4)	124 (9.8)	135 (10.7)	<0.001
1 vessel diseased, n (%)	351 (27.7)	316 (24.9)	307 (24.3)	0.117
2 vessels diseased, n (%)	338 (26.7)	379 (29.9)	358 (28.3)	0.212
Multi-vessels diseased, n (%)	347 (27.4)	411 (32.4)	473 (37.4)	<0.001
Gensini score	16 (4–36)	21 (6–44)	26 (10–52)	<0.001
MACEs, n (%)	99 (7.8)	103 (8.1)	145 (11.5)	0.002

Data are expressed as mean (SD), median (IQR) or n (%). Bold values indicate statistical significance. Hs-CRP: high sensitivity C-reactive protein; LVEDD: left ventricular end diastolic diameter; LVEF: left ventricular ejection fraction; CAD: coronary artery disease; LM: left main coronary artery; MACEs: major adverse cardiovascular events.

Figure 3. The event-free survival analysis among monocyte (A) or MHR (B) tertiles.

Figure 4. The ROC analysis revealing the value of MHR (A) and MC (B) in predicting the future MACEs.

Table 3. Univariate Cox proportional hazard models results of the MACEs.

	Univariate model
	HR	95%CI	p value
Age	1.016	1.005–1.027	0.005
Male	1.095	0.866–1.386	0.448
BMI	0.995	0.962–1.028	0.756
Hypertension	1.607	1.269–2.035	<0.001
Diabetes mellitus	1.390	1.110–1.740	0.004
Dyslipidaemia	1.198	0.928–1.545	0.165
Smoking	0.973	0.788–1.202	0.801
Family history of CAD	1.023	0.777–1.349	0.870
Angiography proven CAD	7.692	3.639–16.258	<0.001
Gensini score	1.011	1.008–1.013	<0.001
Hs-CRP	1.027	0.997–1.059	0.083
WBC count	1.095	1.030–1.164	0.004
MC	3.105	1.774–5.436	<0.001
Monocyte to HDL-C ratio	2.187	1.390–3.441	0.001

Bold values indicate statistical significance. BMI: body mass index; CAD: coronary artery disease; hs-CRP: high-sensitivity C-reactive protein; WBC: white blood cell; HDL-C: high density lipoprotein cholesterol.

Table 4. Predictive value of white blood cell subsets and MHR tested by multivariate Cox proportional hazard models.

	Multivariate model
	HR	95%CI	p value
Model 1
WBC count	1.091	1.026–1.160	0.005
Neutrophil count	1.114	1.034–1.200	0.005
Lymphocyte count	1.003	0.846–1.189	0.974
MC	3.154	1.802–5.520	<0.001
HDL-C	0.801	0.538–1.192	0.274
Monocyte to HDL-C ratio	2.356	1.489–3.729	<0.001
Model 2
WBC count	1.070	1.005–1.140	0.035
Neutrophil count	1.092	1.010–1.179	0.026
Lymphocyte count	0.984	0.828–1.170	0.857
MC	2.734	1.547–4.832	0.001
HDL-C	0.911	0.605–1.372	0.655
Monocyte to HDL-C ratio	2.031	1.268–3.254	0.003

Multivariate Cox proportional regression analyses were applied. Model 1 was adjusted for age, hypertension, and diabetes mellitus. Model 2 was adjusted for model 1 and Gensini score. Bold values indicate statistical significance. WBC: white blood cell; HDL-C: high density lipoprotein cholesterol.