Association of Monocyte to High-Density Lipoprotein Ratio with FRS and as a Predictor of Cardiovascular Risk in Individuals with Psoriasis

doi:10.21203/rs.3.rs-3326829/v1

Background

Monocyte to high-density lipoprotein cholesterol Ratio (MHR) has been found to be a new inflammatory biomarker related to cardiovascular diseases (CVDs). The current retrospective study focused on exploring the relationship between MHR and Framingham risk score (FRS) and the prognostic significance of this relationship in mid to high risk CVDs in individuals with psoriasis vulgaris.

Methods

In the present study, 128 patients with psoriasis vulgaris and 120 normal controls were involved. In addition, neutrophil to high-density lipoprotein cholesterol ratio (NHR), MHR, and neutrophil to lymphocyte ratio (NLR) values of the two groups were retrospectively evaluated. Correlations between MHR and FRS were analyzed.

Results

NHR, MHR, and NLR values of the patients in psoriasis group with moderate to severe cardiovascular risk noticeably increased relative to the controls (p = 0.018, p = 0.002, p༜0.001, respectively). Furthermore, FRS was positively correlated to MHR, NHR, and NLR among the patients with psoriasis (p = 0.002, p = 0.017, and p < 0.001, respectively). Logistic regression identified age, sex, and MHR as the influencing factors for FRS (p < 0.05). On the basis of the ROC curve, the greatest Youden’s index (0.316) could be obtained at MHR of 0.24, with the relevant sensitivity, specificity, and area under ROC curve of 0.729, 0.413, and 0.662 (95% CI of 0.565, 0.758), respectively.

Conclusions

MHR was related to FRS, which could be adopted for predicting medium to high risk of CVDs in patients suffering from psoriasis.

Psoriasis

Cardiovascular diseases

Monocyte

High-density lipoprotein cholesterol

Framingham risk score

Psoriasis represents the frequently seen immune-regulated and chronic inflammatory skin disorder with an approximate prevalence of 2–3% worldwide [1]. This disorder is considered a systemic disease related to cardiovascular diseases (CVDs) [2–4]. Patients with psoriasis have a higher CVD risk, which may be the independent risk factor for CVDs [4]. Moreover, some experts have suggested cardiovascular events were the main reason for death in psoriasis [3].

Inflammation and the environment have significant effects on the pathogenesis of psoriasis. Increased oxidative stress (OS) and angiogenesis exert an important effect during CVD progression, while psoriasis has both of these roles in its development. Therefore, psoriasis exhibits similar pathogenesis to CVDs, such as OS, metabolic syndrome, systemic inflammation, and vascular endothelial cell dysfunction [5].

Inflammation is usually linked with proinflammatory cytokine-mediated circulating monocyte and neutrophil activation [6]. Monocyte to high-density lipoprotein cholesterol ratio (MHR), neutrophil to high-density lipoprotein cholesterol ratio (NHR), and neutrophil to lymphocyte ratio (NLR) are the novel inflammatory biomarkers that have been newly identified as predictors and prognostic factors for CVD [7–10]. NLR has potentially been a predictor of subclinical atherosclerosis or noncalcified coronary artery burden among patients with psoriasis [7, 8]. Moreover, a countrywide cohort study in the USA revealed that MHR showed a significant association with cardiovascular and all-cause mortality among the general population [9]. Furthermore, NHR is an important indicator in diagnosing and treating early CVD in the normal population [10]. Because MHR, NHR, and NLR are the predictive factors for CVD prognosis, their higher levels can be a warning in detecting and preventing CVDs. Nonetheless, such new inflammatory markers are not extensively analyzed in psoriasis with medium to high-risk CVD.

This study measured the following clinical blood markers in CVDs in patients with psoriasis and the healthy controls: MHR, NHR, and NLR. We hypothesized that psoriasis patients would show higher levels of new inflammatory markers relative to the healthy control individuals with matched age, sex, and body mass index (BMI) and that a specific marker would predict a medium to high risk of CVD in psoriasis vulgaris.

2.1. Participants

Participants were recruited from the Second People’s Hospital of Nantong between January 2018 and December 2022, including 128 outpatients and inpatients with psoriasis vulgaris confirmed by clinical or histopathological examination. A total of 120 patients in the Physical Examination Department of Nantong Second People’s Hospital were selected as the control group. The following patients were excluded: 1) who developed severe liver/kidney disease; 2) who developed an autoimmune disease, including systemic lupus erythematosus, Hashimoto’s thyroiditis, or rheumatoid arthritis; 3) who developed severe cardiovascular diseases; 4) who developed malignant diseases; 5) who showed pregnancy or lactation; 6) who showed any evidence of concomitant inflammatory disease, acute infection, or chronic inflammation status; 7) who took lipid-lowering drugs within 3 m to eliminate factors affecting lipid levels; 8) who has a history of systemic psoriasis treatment.

2.2. Data extraction

The current study gained approval from the ethics committee of the Second People's Hospital of Nantong and was carried out following the Declaration of Helsinki.

1) Clinical data

Clinical characteristics including gender, age, duration, personal history, and comorbidities (hypertension, diabetes, coronary artery disease, hyperlipidemia, inflammatory bowel disease, and Hashimoto’s thyroiditis) were considered. BMI was identified by the weight divided by height squared (kg/m2).

2) Laboratory data

Fasting venous blood was sampled for blood routine data (white blood cell (WBC), platelet (PLT), neutrophil, lymphocyte, and monocyte cell counts, CRP, triglycerides (TG), total cholesterol (TC), high/low-density lipoprotein cholesterol (HDL-c/LDL-c), albumin (Alb), and blood glucose levels). The MHR, NHR, and NLR levels in participants were measured.

3) Psoriasis Area and Severity Index (PASI) and Framingham risk score (FRS)

In the present study, psoriasis intensity/severity was determined based on baseline disease status features (desquamation, skin infiltration, and erythema) and represented by the psoriasis area and severity index (PASI) score. The PASI scores were determined by two dermatological physicians, and their mean value was calculated. Psoriasis severity was evaluated as mild-to-moderate (PASI ༜ 10) and severe (PASI ≥ 10) [11]. FRS, developed as a parameter to assess CVD risk, estimates the 10-year risk of heart disease. It is calculated from the following indicators: patients’ age, gender, and smoking history, HDL-c, TC, systolic blood pressure, and anti-hypertensive drug use. The risk is classified as low (< 10%), intermediate (10–20%), or high (> 20%) [12].

2.3. Statistical analysis

Data were explored with SPSS, version 27. Based on Kolmogorov–Smirnov test, continuous data were first tested for their normal distribution. The normally distributed data were shown to be mean ± standard deviation, while the categorical data were summarized as absolute numbers or percentage values. Intergroup differences were assessed with Student’s t-test or Mann–Whitney U test. The gap among the three groups was investigated with one-way ANOVA or Kruskal–Wallis test. Spearman’s or Kendall’s tau coefficient correlation coefficient was computed to study the relationship between the two factors. Additionally, we used a binary logistic regression model for analyzing influencing factors for mid-high-risk CVD in patients with psoriasis.

Furthermore, the ROC curve was plotted to assess the prognostic significance of MHR in individuals with psoriasis vulgaris who had mid-high-risk CVD. P༜0.05 represented a statistically significant difference.

3.1. Basic features

The current study involved 128 cases (psoriasis vulgaris) and 120 controls. The study comprised 92 male patients with psoriasis and 85 male healthy controls. Differences between the two groups had no significance in accordance with their gender and age (p = 0.856, p = 0.183). The former group included 22 smokers, and the latter included 15 (p = 0.3). The PASI score for the patient group was 1.3–28.3 (median, 8.1; first and third quartiles, 4.93–11.79).

The differences in WBC, neutrophils, monocytes, PLT, LDL-c, and NLR showed statistical significance when the laboratory investigation data were compared (p = 0.034, p = 0.021, p = 0.002, p < 0.001, p < 0.001, p = 0.036, Table 1).

Table 1 Demographic features and laboratory parameter values for psoriasis and control group.

	Psoriasis(n=128)	Controls(n=120)	Z(t) value	p value
Demographic characteristics
Age	52(40.25,62)	54.5(45,66.75)	-1.332	0.183
Gender(M/F)	92(71.9)/36(28.1)	85(70.8)/35(29.2)	0.033	0.856
BMI(kg/m2 )	23.57±2.35	23.13±2.28	1.488	0.138
Smoker,n(%)	22(17.19)	15(12.5)	1.072	0.3
Diabetes mellitus, n (%)	25(19.53)	15(12.5)	2.264	0.132
Onset time (month)	96(48,213)
PASI	8.1(4.93,11.79)
Laboratory parameters
WBC(×10^9/L)	6.0(5.1,7.6)	5.75(4.83,6.7)	-2.124	0.034
Neu(×10^9/L)	3.7(3.3,4.4)	3.4(2.8,4.28)	-2.304	0.021
Lym(×10^9/L)	1.8(1.5,2.2)	1.8(1.4,2.3)	-0.09	0.929
Mon(×10^9/L)	0.3(0.3,0.4)	0.3(0.2,0.4)	-3.093	0.002
PLT(×10^9/L)	217.5(181.3,267.5)	153(141,168)	-8.332	<0.001
TG(mmol/L)	1.50(0.99,2.28)	1.42(0.94,2.21)	-0.599	0.549
TC(mmol/L)	4.69±0.81	4.68±0.78	0.066	0.948
HDL(mmol/L)	1.26(1.09,1.42)	1.21(1.02,1.51)	-1.124	0.261
LDL(mmol/L)	3.18±0.74	2.72±0.71	4.989	＜0.001
Nover Ratio
TC/HDL	3.60(3.07,4.2)	3.89(3.05,4.49)	-1.014	0.311
NHR	2.89(2.33,3.95)	2.70(2.04,3.94)	-1.646	0.1
MHR	0.25(0.20,0.36)	0.24(0.17,0.32)	-1.918	0.055
NLR	2.16(1.65,2.72)	1.94(1.43,2.44)	-2.094	0.036

Abbreviations: M: male; F: female; BMI: body mass index; WBC: white blood cell; Neu: neutrophile; Lym: lymphocyte; Mon: monocyte; PLT: platelet; TG: triglyceride; TC: total cholesterol; HDL/LDL: high/low-density lipoprotein; NHR: neutrophil to high-density lipoprotein cholesterol ratio; MHR: monocyte to high-density lipoprotein cholesterol ratio; NLR: neutrophil to lymphocyte ratio

Mean ±SD was analyzed by Student’s t-test for independent samples.

Median (first and third quartiles) was obtained from the Mann-Whitney U test.

3.2. MHR, NHR, and NLR of the patients with psoriasis showing an elevated moderate-severe cardiovascular risk

Patients with psoriasis were categorized into two subgroups based on FRS as mild and moderate-severe grades (mild: FRS＜10% or moderate to severe: FRS ≥ 10%).

The moderate-severe group included 48 patients, whereas the mild group had 80 subjects.

Differences in values of age, BMI, Lym, Mon, PLT, HDL, and LDL were of statistical significance among the three groups (p ＜ 0.001, p = 0.045, p = 0.005, p = 0.002, p ＜ 0.001, p = 0.007, and p ＜ 0.001, respectively) (Table 2). Pairwise comparisons revealed that the NHR, MHR, and NLR values of the patients with psoriasis showing moderate-severe cardiovascular risk increased relative to the controls (p = 0.018, p = 0.002, and p＜0.001, respectively). Notably, psoriasis patients with mid-to-high cardiovascular risk had higher MHR and NLR than those with low-risk CVD (p = 0.01 and p = 0.001, respectively)(Figure 1).

Table 2 Laboratory data in patients with psoriasis and controls based on CVD risks.

	Mild FRS＜10% (n=80)	Moderate to severe FRS≥10%(n=48)	Controls(n=120)	H (F)value	p value
Age	46(33.25,52.75)	63(54.25,68.75)	54.5(45,66.75)	39.259	＜0.001
BMI(kg/m²)	23.21(21.63,24.96)	23.88(22.36,25.61)	23.12(21.57,24.40)	6.224	0.045
WBC(×10^9/L)	6.05(5.1,7.6)	6(4.85,8.28)	5.75(4.83,6.7)	4.641	0.098
Neu(×10^9/L)	3.7(3.03,4.4)	3.75(3.03,5.18)	3.4(2.8,4.28)	5.993	0.05
Lym(×10^9/L)	1.9(1.6,2.28)	1.6(1.3,2)	1.8(1.4,2.3)	10.666	0.005
Mon(×10^9/L)	0.3(0.3,0.4)	0.4(0.3,0.5)	0.3(0.2,0.4)	12.668	0.002
PLT(×10^9/L)	223.5(194.5,272.75)	212.5(164.25,258.5)	153(141,168)	74.816	＜0.001
TG(mmol/L)	1.52(0.93,2.02)	1.48(1.09,2.62)	1.42(0.94,2.21)	1.669	0.434
TC(mmol/L)	4.67±0.80	4.71±0.83	4.68±0.78	0.044	0.957
HDL(mmol/L)	1.30(1.2,1.52)	1.21(1.03,1.39)	1.21(1.02,1.51)	9.899	0.007
LDL(mmol/L)	3.07(2.5,3.58)	3.31(2.68,3.76)	2.72(2.25,3.15)	22.694	＜0.001
NHR	2.76(2.13,3.8)	3.26(2.49,4.28)	2.70(2.04,3.94)	7.962	0.019
MHR	0.23(0.18,0.32)	0.31(0.23，0.40)	0.24(0.17,0.32)	12.372	0.002
NLR	1.95(1.51,2.47)	2.45(2.01,3.06)	1.94(1.43,2.44)	17.821	＜0.001
PASI	6.18(3.88,11.66)	9.53(7.54,12.64)

Abbreviations: BMI: body mass index; WBC: white blood cell; Neu: neutrophile; Lym: lymphocyte; Mon: monocyte; PLT: platelet; TG: triglyceride; TC: total cholesterol; HDL: high density lipoprotein; LDL: low density lipoprotein; NHR: neutrophil to high-density lipoprotein cholesterol ratio; MHR: monocyte to high-density lipoprotein cholesterol ratio; NLR: neutrophil to lymphocyte ratio; PASI: Psoriasis area and severity index; FRS: Framingham risk score

One-way ANOVA for normal continuous variables, reported as mean ±SD.

The Kruskal-Wallis test for non-normally distributed variables is reported as median (the first quartile, third quartile). Post hoc pairwise comparisons were made by Bonferroni correction.

3.3. Correlation of the FRS grade and MHR with clinical indicators in patients with psoriasis

FRS was positively correlated to MHR, NHR, and NLR in patients with psoriasis ( p = 0.002, p = 0.017, and p < 0.001, respectively)(Figure 2), whereas it was negatively related to lymphocyte counts (r = −0.293, p＜0.001). Furthermore, FRS was related to traditional inflammatory factors such as CRP (p = 0.027) and ESR (p = 0.043) (Table 3). Finally, other cardiometabolic risk factors significantly correlated with FRS in psoriasis included age, gender, and HDL. MHR exhibited positive relation to gender (r = 0.293, p＜0.001), PASI grade (r = 0.241, p = 0.006), CRP (r = 0.245, p = 0.005), WBC counts (r = 0.545, p＜0.001), neutrophile counts (r = 0.497, p＜0.001), monocyte counts (r = 0.87, p＜0.001), lymphocyte counts (r = 0.267, p = 0.002), PLT (r = 0.189, p = 0.033) and TG (r = 0.337, p＜0.001). Moreover, MHR displayed negative relation to HDL in psoriasis groups (r = –0.574, p＜0.001) (Table 3).

Table 3 Correlation between FRS grade as well as MHR and clinical data in patients with psoriasis.

	FRS grade		MHR
	Rho(tau—b)	p value	Rho	p value
Age	0.561	＜0.001	-0.089	0.319
Gender(M/F)	-0.269	0.002	-0.293	＜0.001
BMI(kg/m2 )	0.14	0.114	-0.035	0.693
Smoking	0.16	0.071	0.031	0.73
Diabetes mellitus	0.148	0.096	0.094	0.291
PASI grade	0.106	0.234	0.241	0.006
CRP(mg/L)	0.196	0.027	0.245	0.005
ESR(mm/h)	0.179	0.043	0.016	0.858
WBC(×10^9/L)	-0.028	0.752	0.545	＜0.001
Neu(×10^9/L)	0.076	0.396	0.497	＜0.001
Lym(×10^9/L)	-0.293	＜0.001	0.267	0.002
Mon(×10^9/L)	0.154	0.082	0.870	＜0.001
PLT(×10^9/L)	-0.177	0.046	0.189	0.033
TG(mmol/L)	0.095	0.286	0.337	＜0.001
TC(mmol/L)	0.045	0.616	-0.107	0.23
HDL(mmol/L)	-0.278	0.002	-0.574	＜0.001
LDL(mmol/L)	0.127	0.153	0.098	0.272
NHR	0.211	0.017	0.712	＜0.001
MHR	0.271	0.002	——	——
NLR	0.333	＜0.001	0.228	0.01

Abbreviations: BMI: body mass index; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; WBC: white blood cell; Neu: neutrophile; Lym: lymphocyte; Mon: monocyte; PLT: platelet; TG: triglyceride; TC: total cholesterol; HDL: high density lipoprotein; LDL: low density lipoprotein; NHR: neutrophil to high-density lipoprotein cholesterol ratio; MHR: monocyte to high-density lipoprotein cholesterol ratio; NLR: neutrophil to lymphocyte ratio; PASI: Psoriasis area and severity index; FRS: Framingham risk score

3.4. Results of logistic regression in patients with psoriasis showing the moderate-high CVD risk within 10 y

CVD risk can be categorized as: ＜10% as low and ≥10% as medium-high. Psoriasis group served as a dependent variable (FRS ＜10% = 0, FRS ≥ 10% = 1). Meanwhile, those collected relevant clinical data were used as independent variables (CRP, lymphocyte counts, PLT, and HDL-c, which were associated with MHR to prevent multicollinearity, were excluded). Based on the results, the gender, age, and MHR were the influencing factors for CVD risk grade in Framingham in the patients with psoriasis (p < 0.05, Table 4).

Table 4 Medium-high CVD risk among patients with psoriasis determined using binary logistic regression analysis.

Variable	β	SE	Wald χ²	p value	OR	95% CI
Gender(M)	3.418	0.886	14.871	＜0.001	30.523	(5.371,173.458)
Age	0.197	0.04	24.089	＜0.001	1.218	(1.126,1.317)
ESR(mm/h)	0.048	0.029	2.819	0.093	1.049	(0.992,1.11)
NHR	0.235	0.303	0.599	0.439	1.264	(0.698,2.29)
MHR	0.287	0.131	4.808	0.028	1.332	(1.031,1.721)
NLR	0.425	0.396	1.156	0.282	1.53	(0.705,3.323)

Abbreviations: ESR: erythrocyte sedimentation rate; NHR: neutrophil to high-density lipoprotein cholesterol ratio; MHR: monocyte to high-density lipoprotein cholesterol ratio; NLR: neutrophil to lymphocyte ratio

Notes: Because the MHR value is small, the HDL unit: mmol/L is converted to mg/dL in regression.

3.5. ROC curves of MHR for the identification of FRS in patients with psoriasis

ROC curves of MHR in relation to FRS are shown in Figure 3. The threshold for the MHR in predicting medium-high risk of CVD in patients with psoriasis according to the ROC curve was 0.316, and the sensitivity and specificity were 72.9% and 41.3%, respectively (Figure 3). In line with the ROC curves, the area under curve value was 0.662 (95% CI of 0.565, 0.758).

The present study showed that the patients with psoriasis with moderate-severe CVD risk show significantly higher NHR, MHR, and NLR values than those in the patients with mild cardiovascular risk and controls. Moreover, the findings revealed the relationship between FRS and MHR in patients with psoriasis. Moreover, the current study is the first to show increased NHR value among patients with psoriasis, although the difference was not of statistical significance between the two groups. WBC, neutrophile, monocyte, platelet, and LDL-c counts of the psoriasis groups increased relative to those in healthy individuals. Our findings conformed to those in the previous reports [13, 14], which suggested that patients had statistically significant higher levels of the aforementioned experimental indicators. Neutrophils generate numerous inflammatory factors, cytokines, and the “neutrophil extracellular traps” [13]. NLR expression is significantly elevated in psoriasis [13, 15-17]. Two Turkish studies [6, 15] successively reported statistically different MHR in psoriasis and control groups in 2019 and 2020, respectively. According to Aktaş Karabay et al. [15], MHR and NLR were statistically different in the patients relative to those in the control groups; however, in this study, only the NLR exhibited statistical differences (p = 0.036). The MHR of the psoriasis group was increased but not statistically significant. Thus, the expression of MHR in psoriasis remained controversial. This could be due to the large proportion of mild diseases in the psoriasis group.

Atherosclerosis is a pathological process related to psoriasis and CVDs, and the latter two have similar pathogenic characteristics. They all include systemic and local immune progression and the involvement of inflammatory cytokines or markers [18]. Increased neutrophil, monocyte, and lymphocyte, whereas declined HDL-C, are linked to inflammation [15].

Monocytes are a unique type of leukocyte whose activation can be observed in the arterial wall and blood circulation. The intermediate subset of monocytes (CD14 + CD16 +; IM), as well as nonclassical monocytes (CD-14 + CD16 +; NCM), represent proinflammatory cells, and they can be cellular markers for atherosclerosis and are related to psoriasis pathogenesis [19]. HDL-c exhibits anti-inflammatory effects and immunomodulatory functions by regulating monocytes, macrophages, lymphocytes, and dendritic cells. According to the proinflammatory effects of monocytes, together with the anti-inflammatory effects of HDL-c, MHR was the new inflammatory biomarker indicating systemic inflammation and OS [9]. MHR is related to inflammatory diseases such as CVDs, hypertension, and diabetes [9, 20, 21]. High MHR and NLR values are currently associated with the dismal prognosis of CVDs [9, 20]. Nevertheless, no article explicitly indicated the association of MHR with the cardiovascular risk of psoriasis. Funda Tamer et al. reported that the MHR the patients with psoriasis remarkably declined following ixekizumab treatment and suggested that ixekizumab might positively affect treatment in patients with psoriasis developing CVDs [21]. According to our findings, the MHR of patients with psoriasis with FRS ≥ 10% increased relative to those with low cardiovascular risk (FRS＜10%). Further analysis determined the correlation of MHR with inflammatory and blood lipid markers in the psoriasis population. Consequently, MHR level showed significantly positive values in relation to WBC, neutrophile, lymphocyte, monocyte, platelet, and TG counts, which are indicators of angiocardiopathy. In addition, the MHR level showed a significantly negative relation to HDL-c, a protective indicator for coronary heart disease. Another important finding of the current work was that MHR was related to FRS of psoriasis patients. Therefore, MHR is important for predicting high-risk cardiovascular risk in patients with psoriasis.

Activated neutrophils are primarily responsible for producing reactive oxygen species and degranulation. Their role in the immunopathogenesis of psoriasis and atherosclerosis has been described [22, 23]. During the early stage, adhesion and extravasation to the arterial wall by neutrophils can promote LDL-c accumulation and infiltration. In later stages, it leads to plaque instability and eventually results in atherothrombotic events [24]. NLR is a valuable indicator for subclinical systemic inflammation and cardiovascular risk prediction. An earlier study found that NLR elevated among the patients with psoriasis developing CVD relative to patients with no CVD, and it was related to hs-CRP, carotidintimal media thickness, and carotid vascular inflammation. Furthermore, it also demonstrated that NLR was associated with mRNAs and proteins in circulation linked with neutrophil degranulation. The findings from all these experiments indicated that NLR may be the biomarker for subclinical CVD among patients with psoriasis [25]. Conforming to prior reports [8, 25], NLR was found to be elevated among the patients with psoriasis and positively associated with FRS grade. Unfortunately, we did not find NLR as a factor affecting the high risk of CVD in patients with psoriasis in the regression analysis.

As a novel inflammatory marker, NHR was associated with poor clinical prognosis. As discovered by some scholars, NHR is the novel factor independently predicting the all-cause mortality risk of patients receiving peritoneal dialysis, which is significantly related to new cardiovascular events [26]. Neutrophils can promote inflammatory cell infiltration and aggregation, platelet aggregation, and cause vascular blockage and stenosis [27]. After activation, neutrophils modulate HDL oxidation while impairing cholesterol because they possess oxidant-producing enzymes [28]. Conversely, HDL-c suppresses inflammation, as illustrated by its effects on reducing neutrophil activation, adhesion, and migration [29]. Thus, an essential and complex neutrophil-HDL-c interaction is observed. The higher NHR in a patient implies the presence of a higher neutrophil count and/or lower HDL-c concentration. As shown in a study including 211 hospitalized patients with acute coronary syndrome complicated by type 2 diabetes (T2D), NHR independently predicted the acute coronary syndrome risk in T2D patients [30]. According to another study conducted in China [31], high NHR independently predicted a high Gensini score. No study assessing NHR in psoriasis has been reported to date; nonetheless, based on our findings, NHR notably increased among patients with psoriasis (FRS ≥ 10%) relative to that in the healthy controls (p = 0.018).

All the parameters studied (MHR, NLR, and NHR) of the patients with psoriasis showing moderate-severe cardiovascular risk considerably increased relative to the controls (p = 0.018, p = 0.002, and p ＜ 0.001, respectively) and were positively related to the FRS grade (r = 0.211, p = 0.002; r = 0.271, p = 0.017; and r = 0.333, p < 0.001). Herein, the MHR and NLR significantly differed in two psoriasis groups stratified by FRS (p = 0.01 and p = 0.001, respectively). Consequently, the aforementioned parameters can be applied in the follow-up of psoriasis with CVD.

In addition, only MHR was the influencing factor for the patients with psoriasis at medium-high cardiovascular risk, as revealed by binary regression. Among the factors analyzed, MHR shows higher reliability in predicting high-risk cardiovascular disease in psoriasis. To evaluate the prognostic significance of the MHR level in medium-high risk of CVDs in psoriasis vulgari, ROC analysis was carried out to determine the threshold, sensitivity, specificity, and AUC of MHR. According to our findings, the MHR level was the novel complementary biomarker, which can be used in combination with conventional cardiac biomarkers to predict the risk of intermediate to high-risk CVDs among psoriasis cases.

Despite providing some valuable insights, the present study still has certain limitations. First, it was a uni-center and retrospective study. Therefore, the findings should be interpreted cautiously. Second, we used FRS outcomes instead of hard cardiovascular endpoints, which may limit the ability to derive definite conclusions. Third, FRS may have a subjective bias due to collective uncertainty related to smoking and blood pressure. Therefore, the results require further confirmation from extensive evidence-based clinical and large-scale prospective studies.

According to our findings, MHR increased in patients with psoriasis with medium-high cardiovascular risk and was positively correlated with FRS. Therefore, MHR may become a potentially useful inflammatory parameter for identifying patients with psoriasis with medium-high cardiovascular risk.

MHR Monocyte to high-density lipoprotein cholesterol Ratio

CVDs Cardiovascular diseases

FRS Framingham risk score

NHR Neutrophil to high-density lipoprotein cholesterol ratio

NLR Neutrophil to lymphocyte ratio

OS Oxidative stress

BMI Body mass index

WBC White blood cell

PLT Platelet

TG Triglycerides

TC Total cholesterol

HDL-c High density lipoprotein cholesterol

LDL-c Low-density lipoprotein cholesterol

Alb Albumin

PASI Psoriasis Area and Severity Index

T2D Type 2 diabetes

Ethical approval and consent to participate

This study gained approval from the ethics committee of the Second People's Hospital of Nantong (Reference No.2022-072) and was carried out following the Declaration of Helsinki. The informed consent was waived by the Ethics Committee of the Second People's Hospital of Nantong, due to retrospective nature of study.

competing interest

The authors declared no conflicts of interest.

Acknowledgments

This work was supported by Nantong Municipal Health Commission youth Project of China (QNZ2022034). The funders had no role in study design, data collection, analysis, decision to publish, or preparation of the manuscript.

Author contributions

Xueqin Gu, Hongmei Shen: ideas; formulation or evolution of overarching research goals and aims; writing a manuscript(These authors contributed equally to this work and should be considered co-first authors); Jiafeng Jiang: data analysis;harting; Jinfang Ge: revise the manuscript; prepare for publication. Jinfang Ge (corresponding author): ensure that the descriptions are accurate and agreed by all authors.

Data Availability

The datasets generated and/or analyzed during the current study are not publicly available due to the restrictions of human genetics data policy of the Human Ethics Committee of the Second People's Hospital of Nantong, but are available from the corresponding author on reasonable request.

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No competing interests reported.

Association of Monocyte to High-Density Lipoprotein Ratio with FRS and as a Predictor of Cardiovascular Risk in Individuals with Psoriasis

Status:

Version 1

Abstract

Background

Methods

Results

Conclusions

Figures

1. Background

2. Methods

2.1. Participants

2.2. Data extraction

1) Clinical data

2) Laboratory data

3) Psoriasis Area and Severity Index (PASI) and Framingham risk score (FRS)

2.3. Statistical analysis

3. Results

3.5. ROC curves of MHR for the identification of FRS in patients with psoriasis

4. Discussion

5. Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1