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Stimulation of Vascular Endothelial Cells Using Neutrophil Extracellular Traps in the Presence of Low-Density Lipoprotein
Published on: August 12, 2025
Association of the Neutrophil to High-Density Lipoprotein Cholesterol Ratio and Platelet to High-Density Lipoprotein
Ruoling Teng1, Huajie Han1, Yi Ding1
1Department of Geriatrics, The First People's Hospital of Changzhou, Changzhou, Jiangsu, 213000, People's Republic of China.
Insights
Neutrophil to high-density lipoprotein cholesterol ratio (NHR) and platelet to high-density lipoprotein cholesterol ratio (PHR) are linked to early vascular aging (EVA). These inflammatory indices show potential for risk stratification, especially in men and smokers.
Area of Science:
- Cardiovascular Research
- Biomarkers
- Vascular Health
Background:
- Early vascular aging (EVA) is a critical indicator of cardiovascular risk.
- Inflammatory markers derived from complete blood count and lipid profiles may predict EVA.
- Identifying novel biomarkers for EVA is crucial for cardiovascular disease prevention.
Purpose of the Study:
- To investigate the association between complete blood count parameters and lipid metabolism-related inflammatory indices with EVA.
- To assess the independent associations of neutrophil to high-density lipoprotein cholesterol ratio (NHR) and platelet to high-density lipoprotein cholesterol ratio (PHR) with EVA.
- To explore the dose-response relationships and potential effect modifications of these indices on EVA.
Main Methods:
- Cross-sectional study of 1114 participants.
- Logistic regression analysis to determine independent associations of NHR and PHR with EVA.
- Restricted cubic spline models for nonlinear relationship assessment and subgroup analyses for effect modification.
Main Results:
- NHR and PHR were independently associated with increased odds of EVA.
- Associations were essentially linear, with no significant nonlinear relationships detected.
- NHR's association with EVA was stronger in men and smokers, indicating population heterogeneity.
Conclusions:
- NHR and PHR are independently associated with EVA in a cross-sectional population.
- These indices offer a modest net benefit for EVA risk stratification, though clinical utility is currently limited.
- Further prospective, multi-center studies are warranted to validate these findings and explore causal inference.
Purpose:
This cross-sectional study aimed to investigate the association of complete blood count parameters and lipid metabolism‑related inflammatory indices with early vascular aging (EVA).
Methods:
A total of 1114 participants were included with an overall EVA prevalence of 19.6%. Logistic regression was adopted to assess the independent associations of neutrophil to high-density lipoprotein cholesterol ratio (NHR) and platelet to high-density lipoprotein cholesterol ratio (PHR) with EVA after adjusting for traditional cardiovascular risk factors. Restricted cubic spline (RCS) models were applied to examine nonlinear relationships. Subgroup analyses were conducted to evaluate effect modification, and decision curve analysis (DCA) was used to assess the net benefit for risk stratification.
Results:
In the fully adjusted model, both NHR (OR = 1.583, 95% CI: 1.078-2.327, P = 0.019) and PHR (OR = 2.050, 95% CI: 1.325-3.173, P = 0.001) remained independently associated with increased odds of EVA. The RCS analysis did not reveal significant nonlinear relationships for either biomarker (P for non-linearity > 0.05), suggesting that the associations were adequately captured by linear models. Subgroup analyses revealed that the positive association between NHR and EVA risk was more pronounced in men and smokers. For PHR, there was no significant interaction among different subgroups. DCA demonstrated that both NHR and PHR conferred modest net benefit gains (maximum 0.0127 and 0.0162, respectively) across clinically relevant threshold probabilities.
Conclusion:
In this cross‑sectional population, both NHR and PHR were independently associated with EVA, with essentially linear dose‑response relationships. The association between NHR and EVA was particularly significant in men and smokers, showing population heterogeneity. Both indices provided a modest net benefit for identifying individuals with EVA, but the modest magnitude of this benefit suggests limited immediate clinical utility. Limitations include the cross‑sectional design and single‑center cohort, which limit causal inference and generalizability. Further prospective, multi‑center studies are needed to validate these findings.
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