The monocyte-to-high-density lipoprotein ratio is associated with the occurrence of atrial fibrillation among NAFLD patients: A propensity-matched analysis

Abstract

BackgroundAccumulating evidence suggests that patients with nonalcoholic fatty liver disease (NAFLD) have a significantly high risk of incident atrial fibrillation (AF). Systemic inflammation, metabolic disorders and oxidative stress could be the potential mechanisms by which NAFLD drives AF. Monocyte-to- high-density lipoprotein ratio (MHR) has emerged as a novel biomarker of inflammation and oxidative stress that has not been studied in AF with NAFLD patients. We aimed to investigate the relationship between MHR and the risk of AF among NAFLD patients.MethodsA retrospective analysis was performed for the clinical data of the patients with NAFLD in the Second Hospital of Shanxi Medical University from January 2019 to October 2022, among whom 204 patients with AF were enrolled as NAFLD+AF group and 613 patients without AF were enrolled as NAFLD control, and 152 patients were selected from each group based on propensity score matching (PSM) at a ratio of 1:1 to balance the covariates between groups. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups; the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. Logistic regression analysis was performed to identify the independent predictor for occurrence of AF among NAFLD patients. Trend chi-square test to analyze the prevalence of AF among MHR tertiles, and then the correlation between MHR and the risk of AF confirmed by restricted cubic splines (RCS). The receiver operating characteristic (ROC) curve analysis was used to determine the optimum MHR cutoff value to predict AF.ResultsUnivariate analysis showed that AF patients had higher MHR than non-AF 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 AF after adjusting for confounding risk factors (OR = 10.67, 95% CI 2.17-52.37, P = 0.004). TC、HDL-C were also independent risk factors for AF. Among them, TC and HDL-C are protective factors for AF. The trend chi-square test showed that the risk of AF increased with an increase in MHR (P < 0.05). However, the RCS showed a nonlinear and J-shaped relationship between MHR and the risk of AF (P for non-linearity = 0.023). The occurrence of AF increased with increasing MHR only when MHR > 0.44. The ROC curve showed that MHR combined with traditional risk factors can improve the ability to predict AF.ConclusionMHR is an independently associated with incident AF in patients with NAFLD and show a certain predictive value.

Monocyte to high-density lipoprotein cholesterol ratio is associated with cerebral small vessel diseases

“…MHR is an indicator that can be obtained easily, simply, and inexpensively through a simple blood test that is now performed in most health check-ups [ 17 ]. In addition, it has been recognized as a stable inflammatory marker and has recently been used for diagnosis and prognosis in various inflammatory, vascular, and metabolic diseases [ 35 – 40 ]. This is likely to be the case in the area of cerebrovascular disease as well, and our findings suggest the clinical possibility that high MHR values may be helpful in selecting patients at high risk for cSVD who require brain MRI.…”

High-density lipoproteins and non-alcoholic fatty liver disease

“…However, human subjects with NAFLD also contain relatively high remnant cholesterol levels [ 16 ] and exhibit an increased heart rate and systolic blood pressure [ 17 ], which are additional cardiovascular disease risk factors. Importantly, a marked reduction in plasma levels of cholesterol associated with anti-atherogenic high-density lipoproteins (HDL) is frequently detected in human subjects suffering from NAFLD, which also seems to be a significant contributor to the occurrence of cardiovascular complications such as atrial fibrillation in this specific patient population [ 18 ]. HDLs constitute an important class of lipid/protein complexes that are essential for reverse cholesterol transport, the process through which excess peripheral cholesterol is removed from the body [ 19 ].…”