Neutrophil to Lymphocyte Ratio and the Extent of Coronary Artery Disease

Abstract

The neutrophil to lymphocyte ratio (NLR), an inflammatory biomarker, may be of predictive and prognostic value for cardiovascular (CV) events. We evaluated the relationship of NLR with the prevalence and extent of coronary artery disease (CAD) in consecutive patients undergoing elective or urgent coronary angiography. Our population (n ¼ 3738 patients) was divided into NLR quartiles. Higher NLR was associated with aging and established CV risk factors, previous percutaneous coronary revascularization, acute presentation, and more complex pharmacological therapy. The NLR was related to platelet count, white blood cell count, creatinine, glycemia, uric acid, and C-reactive protein (all P ¼ .001) levels but inversely related to hemoglobin (P < .001), total cholesterol (P ¼ .005), and triglycerides (P < .001) levels. The NLR was associated with multivessel disease (P < .001), anterior descending, right coronary arteries (P < .001) or circumflex branch lesions (P ¼ .01), percentage of stenosis (P < .001), coronary calcification (P < .001), and intracoronary thrombus (P < .001) but inversely with in-stent restenosis (P < .001) and thrombolysis in myocardial infarction flow (P ¼ .04). The NLR was directly related to the prevalence of CAD (P ¼ .001) and severe CAD (P < .001). In patients undergoing coronary angiography, the NLR is independently associated with the prevalence and severity of CAD.

Impact of Neutrophil-Lymphocyte Ratio on Long-term Outcomes of Patients with Coronary Chronic Total Occlusion After Percutaneous Coronary Intervention

“…Indeed, in ammation plays an indispensable role in the pathogenesis of atherosclerosis, and an elevation in in ammatory biomarkers represents the activation of coronary artery damage [14]. Mounting evidence suggests that in ammation, including pre-existing systemic in ammation, local vascular in ammation secondary to PCI, plays a central role in promoting neointimal growth and in-stent restenosis [16,22].…”

“…In ammation has been associated with many diseases, such as acute myocardial infarction, chronic heart failure, metabolic disorders, cancer and other cardiovascular disease [12,24,25]. Currently, many in ammatory biomarkers have been used to investigate the relationship between in ammatory response and CAD, including white blood cell count, hs-CRP, PLR, NLR, MPV and interleukin-1 [12][13][14]16]. Furthermore, unlike several comorbidities and cardiovascular risk factors used by the Framingham Coronary Heart Disease Risk Score and the Atherosclerotic Cardiovascular Disease Risk Algorithm [26], some researchers have studied potential novel risk scores that also include in ammatory markers, such as the PLR and NLR values, which have also provided useful information for predicting cardiovascular events in patients with CAD [16,27,28].…”

“…Consequently, a high NLR represents two immune pathways, making it more predictive than the method used to evaluate either parameter individually [23,29]. Several studies have shown that the white blood cell count and its subtypes, neutrophils and lymphocytes, were associated with the prevalence and severity of CAD and its prognosis [14,15,28,30]. Meta-analysis shows that NLR was an independent predictor of hospitalization, long-term cardiovascular events and cardiac mortality in patients with STsegment elevation MI after PCI [31].…”

“…More recently, it has been demonstrated that NLR level is associated with the prevalence and severity of CAD, and the elevated NLR predicts the risk of adverse cardiac events in acute coronary syndrome patients [14,15]. Additionally, higher baseline NLR level was risk factor for the development of in-stent restenosis in CTO patients after PCI [16].…”

Neutrophil-to-lymphocyte ratio in systemic lupus erythematosus is influenced by steroids and may not completely reflect the disease activity

“…[4][5][6][7] The NLR has been found to correlate with clinical disease activity in rheumatoid arthritis, Henoch-Schonlein purpura, malignancy and ischemic heart disease. [8][9][10][11][12] Accumulating evidence suggests that inflammatory markers such as NLR and PLR (platelet-tolymphocyte ratio) are significantly elevated in SLE patients and they have been often recommended as useful markers for assessing disease activity. [13][14][15] Literature also indicates positive correlation between NLR and pulse wave velocity, renal involvement and different classes of renal histological staging, and its use as an additive marker for diagnosing infection in SLE patients.…”