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Inflammation is a shared mechanism in coronary artery disease (CAD) and subsequent heart failure (HF), and circulating monocyte and lymphocyte counts predict CAD severity and outcomes. We investigated whether the monocyte-to-lymphocyte ratio (MLR) correlates with biomarkers of HF and extent of CAD, as well as future HF hospitalizations in patients undergoing coronary angiography. Therefore, we studied 1754 patients undergoing coronary angiography for stable CAD, unstable angina, or myocardial infarction. MLR was determined at blood draw before angiography and related cross-sectionally to HF biomarkers (ejection fraction, N-terminal pro-B-type natriuretic peptide [NTproBNP] levels) and CAD severity, as well as longitudinally with risk of HF hospitalizations during follow-up. In the entire cohort, median (interquartile range) MLR was 0.32 (0.24 to 0.43). High MLR was defined as the upper quartile and significantly associated with nonstable CAD (unstable angina; odds ratio [OR] 1.13, 95% confidence interval 1.06 to 1.21] or myocardial infarction [OR 1.10, 1.04 to 1.16]), more severe CAD (OR 1.39, 1.15 to 1.68), poorer ejection fraction (OR 1.63, 1.29 to 2.05), and higher NTproBNP levels (β 0.78, 0.59 to 0.96), all p <0.001. The associations with nonstable CAD and NTproBNP remained highly significant after covariate adjustment. Over a mean follow-up of 1.3 years, 46 HF hospitalizations occurred. A high MLR was significantly and independently predictive of HF hospitalizations during follow-up (hazard ratio 2.1 [1.1 to 4.1], p = 0.039) after adjustment for covariates and addition of MLR to the basic model significantly improved reclassification. In conclusion, MLR is strongly related to HF markers and predicts HF hospitalizations during follow-up in patients with CAD., (Copyright © 2017. Published by Elsevier Inc.)

Background: Coronary artery disease (CAD) affects both men and women. Cardiovascular biomarkers have been suggested to relate to CAD severity, but data on sex-specificity is scarce. Therefore, we investigated the association of established biomarkers with the severity of CAD in stable patients undergoing coronary angiography in a sex-specific manner., Methods: We studied stable patients undergoing coronary angiography and measured CAD severity by SYNTAX score and biomarker levels (N-terminal pro-brain natriuretic peptide (NT pro-BNP), high-sensitivity CRP (hsCRP), cystatin C (CysC), myeloperoxidase (MPO), high-sensitivity troponin I (hsTnI) and von Willebrand factor (VWF)). We tested for sex differences in SYNergy between percutaneous coronary intervention with TAXUS™ and cardiac surgery (SYNTAX) scores and biomarker levels using multivariable ANCOVA. We investigated the association of biomarker levels with SYNTAX score in a multivariable linear regression with interaction terms for sex., Results: We analysed data on 460 men and 175 women. SYNTAX scores were significantly lower in women (9.99 points vs. 11.88 points). Univariably, hsCRP and hsTnI levels were significantly associated with SYNTAX scores (both β 2.5). In multivariable analysis only hsCRP associated with SYNTAX score (β 1.9, p = 0.009). Sex did not modify the association of biomarkers with SYNTAX score., Conclusion: CAD severity as quantified by SYNTAX score is lower in women than men based on coronary angiography. The association of biomarkers with CAD severity did not differ between the sexes., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)