The Relation Between Atherosclerosis and the Neutrophil–Lymphocyte Ratio

Inflammation plays an important role in the pathophysiology of vascular disease. In this review, we consider the associations between the neutrophil–lymphocyte ratio (NLR; an indicator of inflammation) and vascular disease and its associated risk factors. The NLR has received attention due to its role as an independent prognostic factor for coronary artery disease. The NLR can also be affected by atherosclerotic risk factors, such as hypercholesterolemia, metabolic syndrome, diabetes, and hypertension. Importantly, it can predict mortality in cardiovascular diseases. There are also reports of a positive correlation between the NLR and commonly used inflammatory markers. Inflammation is important not only in pathophysiology but also clinical outcomes of many diseases. The NLR is a widely available, easily derived, and reproducible marker of inflammation. Unlike many other inflammatory markers, the NLR is inexpensive and readily available and it provides additional risk stratification beyond conventional risk scores.

[1]  H. Gunes,et al.  Utility of Neutrophil–Lymphocyte Ratio in Predicting Troponin Elevation in the Emergency Department Setting , 2015, Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis.

[2]  M. Bozbay,et al.  Neutrophil–Lymphocyte Ratio and Platelet–Lymphocyte Ratio Combination Can Predict Prognosis in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention , 2015, Angiology.

[3]  M. Aydın,et al.  The Utility of the Platelet–Lymphocyte Ratio for Predicting No Reflow in Patients With ST-Segment Elevation Myocardial Infarction , 2015, Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis.

[4]  T. Turker,et al.  Neutrophil–Lymphocyte Ratio and Carotid–Intima Media Thickness in Patients With Behçet Disease Without Cardiovascular Involvement , 2015, Angiology.

[5]  C. Gibson,et al.  Predictive Value of Admission Platelet Volume Indices for In-hospital Major Adverse Cardiovascular Events in Acute ST-Segment Elevation Myocardial Infarction , 2015, Angiology.

[6]  M. Duran,et al.  The association of red cell distribution width with in-stent restenosis in patients with stable coronary artery disease , 2015, Platelets.

[7]  Yunus Nazlı,et al.  Preoperative Neutrophil–Lymphocyte Ratio and Saphenous Vein Graft Patency After Coronary Artery Bypass Grafting , 2014, Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis.

[8]  A. Yıldırım,et al.  Predictive value of elevated neutrophil to lymphocyte ratio for long-term cardiovascular mortality in peripheral arterial occlusive disease. , 2014, Journal of cardiology.

[9]  Ş. Çoban,et al.  Neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and mean platelet volume as potential biomarkers for early detection and monitoring of colorectal adenocarcinoma , 2014, European journal of cancer prevention : the official journal of the European Cancer Prevention Organisation.

[10]  Shuqian Wang,et al.  Prognostic value of preoperative inflammatory markers in Chinese patients with breast cancer. , 2014, OncoTargets and therapy.

[11]  Heesang Song,et al.  Usefulness of mean platelet volume as a biomarker for long-term clinical outcomes after percutaneous coronary intervention in Korean cohort: A comparable and additive predictive value to high-sensitivity cardiac troponin T and N-terminal pro-B type natriuretic peptide , 2014, Platelets.

[12]  Z. Yuan,et al.  Combination of mean platelet volume and the GRACE risk score better predicts future cardiovascular events in patients with acute coronary syndrome , 2014, Platelets.

[13]  E. Varol,et al.  Relationship Between Neutrophil–Lymphocyte Ratio and Isolated Low High-Density Lipoprotein Cholesterol , 2014, Angiology.

[14]  Ben Tran,et al.  Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. , 2014, Journal of the National Cancer Institute.

[15]  Yun Gi Kim,et al.  Platelet volume indices are associated with high residual platelet reactivity after antiplatelet therapy in patients undergoing percutaneous coronary intervention. , 2014, Journal of atherosclerosis and thrombosis.

[16]  Zhengwen Liu,et al.  Prognostic role of neutrophil‐to‐lymphocyte ratio in colorectal cancer: A systematic review and meta‐analysis , 2014, International journal of cancer.

[17]  S. Ye,et al.  Prognostic Significance of the Neutrophil-to-Lymphocyte Ratio in Primary Liver Cancer: A Meta-Analysis , 2014, PloS one.

[18]  Guangyu Zhang,et al.  Neutrophil to lymphocyte ratio in relation to risk of all-cause mortality and cardiovascular events among patients undergoing angiography or cardiac revascularization: a meta-analysis of observational studies. , 2014, Atherosclerosis.

[19]  T. Celik,et al.  Carotid Intima-Media Thickness in Patients With Slow Coronary Flow and Its Association With Neutrophil-to-Lymphocyte Ratio , 2014, Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis.

[20]  G. Kalkan,et al.  Demographic and clinical features of 521 Turkish patients with Behçet's disease , 2014, International journal of dermatology.

[21]  C. Ozturk,et al.  Neutrophil–lymphocyte ratio as an important assessment tool , 2014, Expert review of cardiovascular therapy.

[22]  A. Barutcu,et al.  Platelet/lymphocyte ratio and risk of in-hospital mortality in patients with ST-elevated myocardial infarction , 2014, Medical science monitor : international medical journal of experimental and clinical research.

[23]  D. Sert,et al.  Usefulness of neutrophil/lymphocyte ratio as a predictor of amputation after embolectomy for acute limb ischemia. , 2014, Annals of vascular surgery.

[24]  T. Turker,et al.  Neutrophils/Lymphocytes Ratio in Patients With Cardiac Syndrome X and Its Association With Carotid Intima–Media Thickness , 2014, Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis.

[25]  A. Barutcu,et al.  The relationship between high-sensitive troponin T, neutrophil lymphocyte ratio and SYNTAX Score , 2014, Scandinavian journal of clinical and laboratory investigation.

[26]  Xin Gao,et al.  Mean Platelet Volume in Relation to Carotid Atherosclerosis in Normotensive, Euglycemic, and Normolipidemic Chinese Middle-Aged and Elderly Adults , 2014, Angiology.

[27]  Nileshkumar J Patel,et al.  Neutrophil lymphocyte ratio significantly improves the Framingham risk score in prediction of coronary heart disease mortality: insights from the National Health and Nutrition Examination Survey-III. , 2014, International journal of cardiology.

[28]  C. Ergin,et al.  Mean Platelet Volume in Recurrent Aphthous Stomatitis and Behçet Disease , 2014, Angiology.

[29]  D. Bailey,et al.  Neutrophil to Lymphocyte Ratio Predicts Perioperative Mortality Following Open Elective Repair of Abdominal Aortic Aneurysms , 2014, Vascular and endovascular surgery.

[30]  D. Mikhailidis,et al.  Serum endocan levels as a marker of disease activity in patients with Behçet disease. , 2014, Journal of the American Academy of Dermatology.

[31]  H. Kucuk,et al.  Neutrophil-to-Lymphocyte Ratio May Predict Contrast-Induced Nephropathy , 2014, Angiology.

[32]  K. Turkmen,et al.  The relationship between neutrophil‐to‐lymphocyte ratio and vascular calcification in end‐stage renal disease patients , 2014, Hemodialysis international. International Symposium on Home Hemodialysis.

[33]  E. Minar,et al.  Mean platelet volume predicts outcome in patients with asymptomatic carotid artery disease , 2014, European journal of clinical investigation.

[34]  T. Celik,et al.  Aortic Arterial Stiffness is a Moderate Predictor of Cardiovascular Disease in Patients With Psoriasis Vulgaris , 2014, Angiology.

[35]  G. Ertas,et al.  A New Parameter Predicting Chronic Total Occlusion of Coronary Arteries , 2014, Angiology.

[36]  S. Inan,et al.  Neutrophil-to-lymphocyte ratio as a quick and reliable predictive marker to diagnose the severity of diabetic retinopathy. , 2013, Diabetes technology & therapeutics.

[37]  Y. Arbel,et al.  Red blood cell distribution width and the risk of cardiovascular morbidity and all-cause mortality , 2013, Thrombosis and Haemostasis.

[38]  K. Patel,et al.  Comparative analysis of red cell distribution width and high sensitivity C-reactive protein for coronary heart disease mortality prediction in multi-ethnic population: findings from the 1999-2004 NHANES. , 2013, International journal of cardiology.

[39]  G. Grassi,et al.  Comparative Effects of Nebivolol and Metoprolol on Red Cell Distribution Width and Neutrophil/Lymphocyte Ratio in Patients With Newly Diagnosed Essential Hypertension , 2013, Journal of cardiovascular pharmacology.

[40]  T. Celik,et al.  Neutrophil to lymphocyte ratio may be predict of mortality in all conditions , 2013, British Journal of Cancer.

[41]  Rana H. Bachir,et al.  Elevated preoperative neutrophil/lymphocyte ratio as a predictor of increased long-term survival in minimal invasive coronary artery bypass surgery compared to sternotomy , 2013, Journal of Cardiothoracic Surgery.

[42]  H. Yaman,et al.  The Comparative Effects of Valsartan and Amlodipine on Vascular Microinflammation in Newly Diagnosed Hypertensive Patients , 2013, Clinical and experimental hypertension.

[43]  K. Soylu,et al.  The relationship of coronary flow to neutrophil/lymphocyte ratio in patients undergoing primary percutaneous coronary intervention. , 2013, Journal of thoracic disease.

[44]  Ş. Balta,et al.  Higher Neutrophil to Lymhocyte Ratio in Patients With Metabolic Syndrome , 2013, Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis.

[45]  Neeraj Shah,et al.  Neutrophil–Lymphocyte Ratio as a Predictor of Major Adverse Cardiac Events Among Diabetic Population , 2013, Angiology.

[46]  J. Carrero,et al.  Neutrophil to lymphocyte ratio independently predicts cardiovascular events in patients with chronic kidney disease , 2013, Clinical and Experimental Nephrology.

[47]  B. Afşar,et al.  The neutrophil to lymphocyte ratio was associated with impaired myocardial perfusion and long term adverse outcome in patients with ST-elevated myocardial infarction undergoing primary coronary intervention. , 2013, Atherosclerosis.

[48]  Z. Öztürk,et al.  Is there a link between neutrophil-lymphocyte ratio and microvascular complications in geriatric diabetic patients? , 2013, Journal of Endocrinological Investigation.

[49]  T. Celik,et al.  Association Between Coronary Artery Ectasia and Neutrophil–Lymphocyte Ratio , 2013, Angiology.

[50]  I. Sahin,et al.  Effect of Atorvastatin on Hematologic Parameters in Patients With Hypercholesterolemia , 2013, Angiology.

[51]  T. Celik,et al.  OP-106 THE COMPARATIVE EFFECTS OF VALSARTAN AND AMLODIPINE ON VWF LEVELS AND N/L RATIO IN PATIENTS WITH NEWLY DIAGNOSED HYPERTENSION , 2013 .

[52]  A. Gerger,et al.  Neutrophil-to-Lymphocyte Ratio and Its Association with Critical Limb Ischemia in PAOD Patients , 2013, PloS one.

[53]  Ülver Derici,et al.  Neutrophil to Lymphocyte Ratio in Evaluation of Inflammation in Patients with Chronic Kidney Disease , 2013, Renal failure.

[54]  Y. Arbel,et al.  Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients undergoing angiography. , 2012, Atherosclerosis.

[55]  Chi‐Hang Lee,et al.  The long-term predictive value of the neutrophil-to-lymphocyte ratio in Type 2 diabetic patients presenting with acute myocardial infarction. , 2012, QJM : monthly journal of the Association of Physicians.

[56]  C. Gibson,et al.  Relation of neutrophil/lymphocyte ratio to coronary flow to in-hospital major adverse cardiac events in patients with ST-elevated myocardial infarction undergoing primary coronary intervention. , 2012, The American journal of cardiology.

[57]  W. März,et al.  Which leukocyte subsets predict cardiovascular mortality? From the LUdwigshafen RIsk and Cardiovascular Health (LURIC) Study. , 2012, Atherosclerosis.

[58]  A. Oguzhan,et al.  Hematologic Parameters and Angiographic Progression of Coronary Atherosclerosis , 2012, Angiology.

[59]  X. Yang,et al.  Elevated neutrophil to lymphocyte ratio predicts overall and cardiovascular mortality in maintenance peritoneal dialysis patients , 2012, International Urology and Nephrology.

[60]  J. Shim,et al.  Relationship of neutrophil-lymphocyte ratio with arterial stiffness and coronary calcium score. , 2011, Clinica chimica acta; international journal of clinical chemistry.

[61]  R. Agha,et al.  Neutrophil-Lymphocyte Ratio Predicts Medium-Term Survival Following Elective Major Vascular Surgery: A Cross-Sectional Study , 2011, Vascular and endovascular surgery.

[62]  Yan Shi,et al.  Association of neutrophil/lymphocyte ratio with long-term mortality after ST elevation myocardial infarction treated with primary percutaneous coronary intervention. , 2010, Chinese medical journal.

[63]  K. Eagle,et al.  Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. , 2008, The American journal of cardiology.

[64]  Claudio Passino,et al.  Predictive value of elevated neutrophil-lymphocyte ratio on cardiac mortality in patients with stable coronary artery disease. , 2008, Clinica chimica acta; international journal of clinical chemistry.

[65]  G. Hillis,et al.  Preoperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting. , 2007, American heart journal.

[66]  Deepak L. Bhatt,et al.  Usefulness of an elevated neutrophil to lymphocyte ratio in predicting long-term mortality after percutaneous coronary intervention. , 2006, The American journal of cardiology.

[67]  D. Mikhailidis,et al.  Inflammatory markers and the metabolic syndrome. , 2005, Atherosclerosis.

[68]  B. Horne,et al.  Which white blood cell subtypes predict increased cardiovascular risk? , 2005, Journal of the American College of Cardiology.

[69]  R. Gillum,et al.  Counts of neutrophils, lymphocytes, and monocytes, cause-specific mortality and coronary heart disease: the NHANES-I epidemiologic follow-up study. , 2005, Annals of epidemiology.

[70]  M. Sabatine,et al.  Relationship between baseline white blood cell count and degree of coronary artery disease and mortality in patients with acute coronary syndromes ☆: A TACTICS-TIMI 18 substudy , 2003 .

[71]  M. Sabatine,et al.  Relationship between baseline white blood cell count and degree of coronary artery disease and mortality in patients with acute coronary syndromes , 2002 .

[72]  L. Lindbom,et al.  Direct viewing of atherosclerosis in vivo: plaque invasion by leukocytes is initiated by the endothelial selectins , 2001, FASEB journal : official publication of the Federation of American Societies for Experimental Biology.

[73]  A. Malviya,et al.  Association between Coronary Artery Ectasia and Neutrophil:Lymphocyte Ratio , 2018 .

[74]  Ş. Balta,et al.  Red cell distribution width: a novel inflammatory marker in clinical practice. , 2013, Cardiology journal.

[75]  A. Erdem,et al.  Hematological parameters and coronary collateral circulation in patients with stable coronary artery disease. , 2013, Experimental and clinical cardiology.

[76]  T. Celik,et al.  Assessment of the relationship between red cell distribution width and cardiac syndrome , 2013 .