The monocyte to high-density lipoprotein cholesterol ratio is positively associated with the severity of coronary artery disease in patients with nonalcoholic fatty liver disease

Abstract

Background Non-alcoholic fatty liver disease (NAFLD) is an independent risk factor for cardiovascular disease. Inflammation and dyslipidemia have been demonstrated to show excellent influence in atherosclerosis in patients with NAFLD. Monocyte (MON) and high-density lipoprotein cholesterol (HDL-C) ratio (MHR), one of the inflammation markers, is associated with the occurrence and severity of NAFLD. However, evidence of MHR in the risk of coronary artery disease (CAD) among NAFLD patients is limited. Methods We conducted a retrospective study of 612 patients with ultrasonogram-confirmed NAFLD who underwent percutaneous coronary intervention (PCI). All patients were divided into NAFLD + CAD group and NAFLD + non-CAD group. For univariate analysis between the two groups, continuous variables were compared using independent samples t-test or Mann-Whitney test, and categorical variables were compared using chi-square test or Fisher Exact tests. In addition, we used binary logistic regression analysis to identify risk and protective factors associated with CAD, constructed receiver operating characteristic (ROC) curves to assess the predictive value of MHR for CAD, and methodological studies of chi-square test for trend analysis the distribution of Gensini scores in MHR at different levels, and the risk degree of Gensini scores at different MHR levels by ordinal logistic regression. Results The study included a total of 336 CAD patients and 277 non-CAD patients. Univariate analysis showed that CAD patients had higher MHR than non-CAD patients (P < 0.001). Meanwhile, compared with pure NAFLD patients, multivariate logistic regression analysis showed that MHR remained to be an independent risk factor for CAD after adjusting for confounding risk factors (OR = 15.57, 95% CI 4.68–51.85, P < 0.001). At the same time, it was superior to traditional lipid parameters. NHR, NLR, and TG were also independent risk factors for CAD. HDL-C is a protective factor for CAD among NAFLD patients. The ROC curve showed that MHR or other inflammatory markers combined with traditional risk factors can improve the ability to predict CAD. In further study, trend chi-square showed that higher levels of MHR predicted more severe coronary lesions (P < 0.05). Multivariate ordinal logistic regression analysis showed that MHR was independently associated with changes in Gensini score (OR = 2.95, 95% CI 1.78–4.89, P < 0.001). Conclusion The MHR was positively associated with CAD risk among NAFLD patients and reflected coronary atherosclerosis severity.