Association between neutrophil-lymphocyte ratio levels and mortality related to cardiovascular cause and all causes in coronary artery disease patients with low-density lipoprotein cholesterol below 1.4 mmol/L: A multicenter cohort study

Abstract

Background and aims

Neutrophil-lymphocyte ratio (NLR) can reflect the residual risk of patients with coronary atherosclerotic disease (CAD). However, in CAD patients with low density lipoprotein cholesterol (LDL-C) less than 1.4 mmol/L, the relationship between NLR and poor prognosis remains unclear. The purpose of this research is to examine the relationship between NLR and mortality from cardiovascular causes as well as all causes in the study group.

Methods and results

From the beginning of 2007 to the end of 2020, 2749 individuals with LDL-C under 1.4 mmol/L at baseline and CAD diagnosed via coronary angiography were part of this research. The selected population was divided into four groups according to the level of NLR, and Cox regression model was used mainly to evaluate the association between NLR and cardiovascular and all-cause mortality. After a follow-up of median 6 years, a total of 182 cardiovascular deaths and 460 all-cause deaths had occurred. The Cox regression analysis of fully adjusted model showed that an elevated NLR is connected to a higher risk of mortality from cardiovascular cause (HR: 2.18, 95 %CI: 1.38–3.43) and all causes (HR: 1.33, 95 %CI: 1.02–1.74) in the fourth quartile group. Subgroup analysis indicated that younger and middle-aged patients, as well as those with multivessel coronary artery disease, may have a heightened residual risk of inflammation.

Conclusion

NLR can be a useful risk factor indicator for cardiovascular and all-cause mortality in CAD patients with LDL-C levels below 1.4 mmol/L, and it also points to residual risk.