Neutrophil-to-Lymphocyte Ratio in CVD

Study Questions:

What is the relationship between prospectively determined neutrophil-lymphocyte ratios (NLRs) and cardiovascular disease (CVD)?


Prospective associations between NLR and Duffy antigen status with CV outcomes including mortality, coronary heart disease (CHD), stroke, and heart failure (HF) were analyzed from participants in the Jackson Heart Study (JHS) (n = 5,301). Impact of time from NLR measurement to event was also analyzed.


Elevated NLR (>2.15) was significantly associated with an increased risk for all-cause mortality (hazard ratio [HR], 1.40) and CHD (HR, 1.69), after adjusting for confounding variables. However, NLR was less of a robust predictor when the time of event was more distant. The Duffy antigen variant was associated with neutrophil count, and NLR >1.77 was associated with mortality, CHD, stroke, and HF in the Duffy antigen–negative group.


The authors concluded that NLR is prospectively associated with all-cause mortality, CHD, and HF, with closer median time to event diagnoses in the JHS. Duffy antigen variant was associated with a lower baseline NLR and modified the mortality, CHD, stroke, and HF associations.


Elevated NLR may be reflective of a heightened state of systemic inflammation and has been associated with CVD events, including mortality. This analysis confirms these associations, indicating that NLR may be useful in cardiac risk stratification. An elevated NLR may also represent complex underlying biological processes responsible for triggering CVD events (i.e., release of granulocytic myeloid-derived suppressor cells from the bone marrow with lymphocyte suppression), which is supported by the enhanced association between NLR and event diagnosis with reduced time intervals. Use of the NLR may need to be modified depending on Duffy antigen status, which affects neutrophil status. In addition to improved risk stratification, elevated NLR could have therapeutic implications as novel anti-inflammatory strategies become available.

Clinical Topics: Acute Coronary Syndromes, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure

Keywords: Acute Coronary Syndrome, Biological Phenomena, Bone Marrow, Coronary Disease, Granulocytes, Heart Failure, Inflammation, Leukocyte Count, Lymphocytes, Metabolic Syndrome X, Neutrophils, Primary Prevention, Vascular Diseases

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