Author + information
- Nicholas Adamstein,
- Jean MacFadyen,
- Lynda Rose,
- Robert Glynn,
- Nehal Mehta and
- Paul M. Ridker
Inflammation contributes to atherothrombosis. The neutrophil-lymphocyte ratio (NLR) is an inflammatory biomarker that may predict future cardiovascular (CV) events.
60,087 participants were randomized in the CANTOS, JUPITER, SPIRE-1, SPIRE-2, and CIRT trials to receive placebo or canakinumab, rosuvastatin, bococizumab, or methotrexate respectively and followed for major adverse CV events. The NLR was calculated from complete blood counts obtained at randomization. Hazard ratios for major CV events across NLR quartiles were computed using Cox proportional hazards models.
The NLR modestly correlated with IL-6 and hsCRP, but minimally with lipids. In all five trials, baseline NLR predicted CV events and death. The per-quartile increase in risk of composite nonfatal MI, nonfatal stroke, CV death, and hospitalization for unstable angina requiring urgent revascularization (MACE+) was 20% in CANTOS (95% CI 14-25%, P<0.0001), 31% in SPIRE-1 (95% CI 14-49%, P=0.00007), 27% in SPIRE-2 (95% CI 12-43%, P=0.0002), 9% in CIRT (95% CI 0.2-20%, P=0.045), and 11% in JUPITER (95% CI 1-22%, P=0.028, which included any revascularization and all hospitalizations for unstable angina). Adjustment for traditional risk factors and hsCRP only moderately attenuated these effects.
The NLR is an inexpensive and easily-obtained biomarker predictive of CV risk in contemporary primary and secondary prevention cohorts that provides information beyond hsCRP.
Posters Hall_Hall A
Saturday, March 28, 2020, 12:30 p.m.-1:15 p.m.
Session Title: Acute and Stable Ischemic Heart Disease: Clinical 2
Abstract Category: 02. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1163-170
- 2020 American College of Cardiology Foundation