The Association of Lipoprotein(a) and Neutrophil-to-Lymphocyte Ratio Combination with Atherosclerotic Cardiovascular Disease in Chinese Patients

Abstract

Xiaoyu Wang,1 Xiaoli Chen,1 Yanfang Wang,1 Sheng Peng,2 Jingjiang Pi,3 Jinnan Yue,1 Qingshu Meng,1 Jie Liu,1 Liang Zheng,1,4 Paul Chan,5 Brian Tomlinson,6 Zhongmin Liu,1 Yuzhen Zhang1 1Key Laboratory of Arrhythmias of the Ministry of Education of China, Shanghai Heart Failure Research Center, Research Center for Translational Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China; 2Department of Trauma, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, People’s Republic of China; 3Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China; 4Jian hospital, Shanghai East Hospital, Tongji University School of Medicine, Jian, 343006, People’s Republic of China; 5Division of Cardiology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; 6Faculty of Medicine, Macau University of Science and Technology, Macau, People’s Republic of ChinaCorrespondence: Yuzhen Zhang; Zhongmin Liu, Key Laboratory of Arrhythmias of the Ministry of Education of China, Shanghai Heart Failure Research Center, Research Center for Translational Medicine, Shanghai East Hospital, School of Medicine, Tongji University, 150 Jimo Road, Pudong 15New District, Shanghai, 200092, People’s Republic of China, Tel [phone], Email [email protected]; [email protected]: The association of lipoprotein(a) [Lp(a)] with atherosclerotic cardiovascular disease (ASCVD) risk can be modified by chronic systemic inflammation. The neutrophil-to-lymphocyte ratio (NLR) is a reliable and easily available marker of immune response to various infectious and non-infectious stimuli. The purpose of this study was to assess the combined effects of Lp(a) and NLR in predicting the ASCVD risk and coronary artery plaque traits.Methods: This study included 1618 patients who had coronary computed tomography angiography (CTA) with risk assessment of ASCVD. CTA was used to evaluate the traits of coronary atherosclerotic plaques, and the association of ASCVD with Lp(a) and NLR was assessed by multivariate logistic regression models.Results: Plasma Lp(a) and NLR were significantly increased in patients having plaques. High Lp(a) was defined as the plasma Lp(a) level > 75 nmol/L and high NLR as NLR > 1.686. The patients were grouped into four categories according to normal or high NLR and plasma Lp(a) as nLp(a)/NLR-, hLp(a)/NLR-, nLp(a)/NLR+ and hLp(a)/NLR+. The patients in the latter three groups had higher risk of ASCVD compared to the reference group nLp(a)/NLR-, with the highest ASCVD risk in the hLp(a)/NLR+ group (OR = 2.39, 95% CI = 1.49– 3.83, P = 0.000). The occurrence of unstable plaques was 29.94% in the hLp(a)/NLR+ group, which was significantly higher than groups nLp(a)/NLR+, hLp(a)/NLR- and nLp(a)/NLR- with 20.83%, 26.54% and 22.58%, respectively, and there was a significantly increased risk of unstable plaque in the hLp(a)/NLR+ group compared to the nLp(a)/NLR- group (OR = 1.67, 95% CI = 1.04– 2.68, P = 0.035). The risk of stable plaque was not significantly increased in the hLp(a)/NLR+ group compared to the nLp(a)/NLR- group (OR = 1.73, 95% CI = 0.96– 3.10, P = 0.066).Conclusion: The concomitant presence of elevated Lp(a) and higher NLR is associated with increased unstable coronary artery plaques in patients with ASCVD.Keywords: lipoprotein(a), neutrophil to lymphocyte ratio, ASCVD and coronary artery plaque

Keywords

• lipoprotein(a)
• neutrophil to lymphocyte ratio
• ascvd and coronary artery plaque