Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine. Key Laboratory of Viral Heart Diseases, National Health Commission. Key Laboratory of Viral Heart Diseases, Chinese Academy of Medical Sciences, Shanghai, 200032, China.
Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking, Union Medical College, Beijing, 100730, China.
Lipids Health Dis. 2022 Sep 3;21(1):86. doi: 10.1186/s12944-022-01695-x.
This study aimed to examine whether the neutrophil to high-density lipoprotein cholesterol ratio (NHR) can predict cardiovascular outcomes in normoglycemic individuals with elevated fasting glucose levels.
A total of 130,801 participants with normal blood glucose levels were enrolled in the Kailuan study. Participants were categorized according to NHR quartiles and further divided into normal glucose regulation (NGR) and pre-diabetes (pre-DM) subgroups. The follow-up endpoint was major adverse cardiovascular events (CVE), including stroke and myocardial infarction.
Over a median of 12.53 (8.95-13.08) years of follow-up, subjects with NHR levels in the highest quartile experienced more CVE than those with NHR levels in the lowest quartile. Multivariate Cox analyses showed that continuous changes in NHR (hazard ratio, 1.21; 95% confidence interval [CI], 1.15-1.28) and the highest quartile of NHR (hazard ratio, 1.30; 95% CI, 1.21-1.39) were independent predictors of CVE (all P < 0.001). Furthermore, when participants were categorized by both NHR quartile and glucose metabolism status, the NHR level in the highest quartile plus pre-DM group was associated with a 1.60-fold (95% CI, 1.38-1.86; P < 0.001] higher risk of CVE than that in the lowest quartile plus normoglycemic group. Significantly, the addition of NHR only, presence of pre-DM only, or combination of NHR and pre-DM to the prediction algorithm, including traditional risk factors, improved the C-statistic by 0.19, 0.05, and 0.23 (all P < 0.001).
Elevated NHR or fasting blood glucose level were independently associated with a higher risk of CVE among normoglycemic individuals. Moreover, pre-DM participants with high NHR levels tended to have worse prognosis, suggesting that NHR could provide greater risk stratification value than traditional risk factors for subjects with pre-DM.
本研究旨在探讨中性粒细胞与高密度脂蛋白胆固醇比值（NHR）能否预测空腹血糖升高的血糖正常个体的心血管结局。
共纳入 130801 名血糖正常的参与者进行凯伦研究。根据 NHR 四分位数将参与者进行分类，并进一步分为正常血糖调节（NGR）和糖尿病前期（pre-DM）亚组。随访终点是主要不良心血管事件（CVE），包括中风和心肌梗死。
在中位随访时间为 12.53 年（8.95-13.08 年）期间，NHR 水平最高四分位的受试者发生 CVE 的次数多于 NHR 水平最低四分位的受试者。多变量 Cox 分析表明，NHR 的连续变化（危险比，1.21；95%置信区间[CI]，1.15-1.28）和 NHR 的最高四分位（危险比，1.30；95%CI，1.21-1.39）是 CVE 的独立预测因素（均 P < 0.001）。此外，当参与者根据 NHR 四分位和葡萄糖代谢状态进行分类时，NHR 水平最高四分位加 pre-DM 组与 NHR 水平最低四分位加血糖正常组相比，CVE 风险增加 1.60 倍（95%CI，1.38-1.86；P < 0.001）。值得注意的是，仅增加 NHR、仅存在 pre-DM 或 NHR 和 pre-DM 的组合加入到包括传统危险因素的预测算法中，可分别使 C 统计量提高 0.19、0.05 和 0.23（均 P < 0.001）。
在血糖正常的个体中，升高的 NHR 或空腹血糖水平与 CVE 风险升高独立相关。此外，NHR 水平较高的 pre-DM 参与者的预后较差，表明 NHR 比传统危险因素为 pre-DM 患者提供了更大的风险分层价值。
