Predictive value of monocyte-to-HDL and neutrophil-to-HDL cholesterol ratio for obstructive coronary artery disease in Patients undergoing coronary angiography

Background The monocyte-to-high-density lipoprotein cholesterol ratio (MHR) and neutrophil-to-high-density lipoprotein cholesterol ratio (NHR) are emerging composite biomarkers that reflect systemic inflammatory status and lipid metabolism. Although both indices have individually been associated with coronary artery disease (CAD), evidence directly comparing their diagnostic performance for obstructive CAD remains scarce. Objective This study aims to compare the diagnostic performance of MHR and NHR in identifying obstructive CAD among patients undergoing elective coronary angiography. Methods A prospective cohort study was conducted involving patients who underwent diagnostic coronary angiography in Jordan. Obstructive CAD was defined as stenosis of 50% or more in a major epicardial vessel on invasive coronary angiography. Results A total of 215 patients were included, of whom 129 (60%) were male, with a mean age of 58.4 ± 11.4 years; 43.7% had obstructive CAD. After adjusting for age, sex, and prior CAD history in multivariate regression analysis, MHR remained an independent predictor of obstructive CAD (OR = 1.99, 95% CI: 1.34–2.97, p < 0.001), whereas NHR was not independently associated (OR = 1.66, 95%CI: 0.74–3.69, p = 0.21). The clinical model integrating MHR demonstrated an AUC of 0.801 (95% CI: 0.74–0.86); however, this numerical increase was not statistically significant (DeLong test, p = 0.216). Conclusion MHR may have potential value for risk stratification in obstructive CAD. Although adding MHR to the clinical model resulted in a numerically higher AUC, the incremental improvement in discrimination was not statistically significant. Further studies involving larger, multicenter cohorts are needed to establish the incremental predictive and clinical utility of MHR.