The Monocyte-to-high-density Lipoprotein-cholesterol Ratio at Diagnosis is Associated with Cerebrovascular Accident During Follow-up in Patients with Antineutrophil Cytoplasmic Antibody-associated Vasculitis

Overview

Journal J Rheum Dis

Specialty Rheumatology

Date 2024 Jul 3

PMID 38957360

Authors

Jang Woo Ha

Sung Soo Ahn

Jason Jungsik Song

Yong-Beom Park

Sang-Won Lee

Affiliations

Soon will be listed here.

Abstract

Objective: In this study, the association between the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) at diagnosis and poor outcomes of atherosclerosis-related antineutrophil cytoplasmic antibody-associated vasculitis (AAV) during follow-up in patients with AAV was investigated.

Methods: This retrospective study included 138 patients diagnosed with AAV. Their comprehensive medical records were meticulously reviewed. All-cause mortality, cerebrovascular accident (CVA), and acute coronary syndrome (ACS) were evaluated as atherosclerosis-related poor outcomes of AAV. MHR was obtained by dividing monocyte counts (/mm3) by high-density lipoprotein cholesterol (mg/dL) levels.

Results: The median age of the 138 patients was 58.3 years with 44 being male (31.9%). Among the 138 patients, 11 (8.0%) died, and 11 (8.0%) and 9 (6.5%) had CVA, and ACS, respectively. MHR at diagnosis was significantly correlated with the Birmingham vasculitis activity score, erythrocyte sedimentation rate, and C-reactive protein at diagnosis. Among the three poor outcomes of AAV, only CVA during follow-up was significantly associated with MHR at diagnosis, and thus, only CVA was considered an atherosclerosis-related poor outcome of AAV. In the multivariable Cox hazards model analysis, MHR (hazard ratio [HR] 1.195) and serum albumin (HR 0.203) at diagnosis were independently associated with CVA during follow-up. Additionally, patients with MHR at diagnosis ≥3.0 exhibited a significantly higher risk for CVA and lower cumulative CVA-free survival rate than those with MHR at diagnosis <3.0.

Conclusion: This study is the first to demonstrate clinical implications of MHR suggesting that MHR at diagnosis is significantly and independently associated with CVA during follow-up in patients with AAV.

References

Reis Geovanini G, Libby P . Atherosclerosis and inflammation: overview and updates. Clin Sci (Lond). 2018; 132(12):1243-1252. DOI: 10.1042/CS20180306. View

Kelly-Hayes M . Influence of age and health behaviors on stroke risk: lessons from longitudinal studies. J Am Geriatr Soc. 2010; 58 Suppl 2:S325-8. PMC: 3006180. DOI: 10.1111/j.1532-5415.2010.02915.x. View

Tabakovic D, Smith R, Jayne D, Mohammad A . High risk of stroke in ANCA-associated vasculitis-a population-based study. Rheumatology (Oxford). 2022; 62(8):2806-2812. PMC: 10393431. DOI: 10.1093/rheumatology/keac669. View

Watts R, Lane S, Hanslik T, Hauser T, Hellmich B, Koldingsnes W . Development and validation of a consensus methodology for the classification of the ANCA-associated vasculitides and polyarteritis nodosa for epidemiological studies. Ann Rheum Dis. 2006; 66(2):222-7. PMC: 1798520. DOI: 10.1136/ard.2006.054593. View

Liu Z, Fan Q, Wu S, Lei Y . Associations of Monocytes and the Monocyte/High-Density Lipoprotein Ratio With Extracranial and Intracranial Atherosclerotic Stenosis. Front Neurol. 2021; 12:756496. PMC: 8678066. DOI: 10.3389/fneur.2021.756496. View

Grayson P, Ponte C, Suppiah R, Robson J, Craven A, Judge A . 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology Classification Criteria for Eosinophilic Granulomatosis with Polyangiitis. Ann Rheum Dis. 2022; 81(3):309-314. DOI: 10.1136/annrheumdis-2021-221794. View

Pyo J, Lee L, Park Y, Lee S . Comparison of the 2022 ACR/EULAR Classification Criteria for Antineutrophil Cytoplasmic Antibody-Associated Vasculitis with Previous Criteria. Yonsei Med J. 2022; 64(1):11-17. PMC: 9826961. DOI: 10.3349/ymj.2022.0435. View

Mukhtyar C, Lee R, Brown D, Carruthers D, Dasgupta B, Dubey S . Modification and validation of the Birmingham Vasculitis Activity Score (version 3). Ann Rheum Dis. 2008; 68(12):1827-32. DOI: 10.1136/ard.2008.101279. View

Millet A, Pederzoli-Ribeil M, Guillevin L, Witko-Sarsat V, Mouthon L . Antineutrophil cytoplasmic antibody-associated vasculitides: is it time to split up the group?. Ann Rheum Dis. 2013; 72(8):1273-9. DOI: 10.1136/annrheumdis-2013-203255. View

10.

Singh S, Suresh M, Voleti B, Agrawal A . The connection between C-reactive protein and atherosclerosis. Ann Med. 2008; 40(2):110-20. PMC: 3364506. DOI: 10.1080/07853890701749225. View

11.

Jennette J, Falk R, Bacon P, Basu N, Cid M, Ferrario F . 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2012; 65(1):1-11. DOI: 10.1002/art.37715. View

12.

Kim J, Lim S, Park K, Jang H, Choi S . Total and differential WBC counts are related with coronary artery atherosclerosis and increase the risk for cardiovascular disease in Koreans. PLoS One. 2017; 12(7):e0180332. PMC: 5533311. DOI: 10.1371/journal.pone.0180332. View

13.

Jiang M, Yang J, Zou H, Li M, Sun W, Kong X . Monocyte-to-high-density lipoprotein-cholesterol ratio (MHR) and the risk of all-cause and cardiovascular mortality: a nationwide cohort study in the United States. Lipids Health Dis. 2022; 21(1):30. PMC: 8931976. DOI: 10.1186/s12944-022-01638-6. View

14.

Suppiah R, Robson J, Grayson P, Ponte C, Craven A, Khalid S . 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for microscopic polyangiitis. Ann Rheum Dis. 2022; 81(3):321-326. DOI: 10.1136/annrheumdis-2021-221796. View

15.

Shi C, Pamer E . Monocyte recruitment during infection and inflammation. Nat Rev Immunol. 2011; 11(11):762-74. PMC: 3947780. DOI: 10.1038/nri3070. View

16.

Chen J, Li C, Liu Z, Shen Y, Ding F, Shu X . The Role of Monocyte to High-Density Lipoprotein Cholesterol Ratio in Prediction of Carotid Intima-Media Thickness in Patients With Type 2 Diabetes. Front Endocrinol (Lausanne). 2019; 10:191. PMC: 6458254. DOI: 10.3389/fendo.2019.00191. View

17.

Li Y, Zhang M, Xue M, Liu D, Sun J . Elevated monocyte-to-HDL cholesterol ratio predicts post-stroke depression. Front Psychiatry. 2022; 13:902022. PMC: 9354071. DOI: 10.3389/fpsyt.2022.902022. View

18.

Robson J, Grayson P, Ponte C, Suppiah R, Craven A, Judge A . 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for granulomatosis with polyangiitis. Ann Rheum Dis. 2022; 81(3):315-320. DOI: 10.1136/annrheumdis-2021-221795. View

19.

Xi J, Men S, Nan J, Yang Q, Dong J . The blood monocyte to high density lipoprotein cholesterol ratio (MHR) is a possible marker of carotid artery plaque. Lipids Health Dis. 2022; 21(1):130. PMC: 9719628. DOI: 10.1186/s12944-022-01741-8. View