The Correlation Between Monocyte To High-Density Lipoprotein Cholesterol Ratio(MHR)and The Risk Of Ischemic Stroke In Patients With Non-Valvular Atrial Fibrillation

Objective:This study aimed to evaluate the correlation between monocyte to high-density lipoprotein cholesterol ratio（MHR）and ischemic stroke（IS）in individuals with non-valvular atrial fibrillation（NVAF）,so as to offer guidance on stroke prevention and comprehensive care for AF patients.Methods:Data were procured from AF inpatients in the electronic medical record system of the First Affiliated Hospital of Xinjiang Medical University from January 1st,2015 to November 17th,2022.Propensity score matching（PSM）was applied to pair the control and case groups.Binary conditional logistic regression models were utilized to analyze the correlation between MHR quartiles and IS.A multivariate corrected restricted cubic spline（RCS）curve was employed to assess the non-linear association between MHR and IS.Subgroup analysis was performed to estimate the interaction between stratified variables and MHR.Furthermore,a receiver operating characteristic curve（ROC）analysis was utilized to evaluate the recognition capability of CHA₂DS₂-VASc on the occurrence of IS after the inclusion of MHR.Results:A total of 6,312 patients with atrial fibrillation（AF）were enrolled in this study,and after 1:4 propensity matching,a total of 1,912 patients were included in this study,including 383 with acute IS and 1,529 without acute IS.Unadjusted logistic regression revealed that the risk of IS in the highest quartile of MHR was 1.94 times higher than that in the lowest quartile（odds ratio[OR],2.94;95%confidence interval[CI],2.10-4.12;P<0.001）.Fully corrected multifactorial logistic regression models indicated that the highest quartile of MHR was still associated with a 1.73-fold increased risk of IS（OR,2.73;95%CI,1.83-4.07;P<0.001）.A nonlinear relationship between MHR and IS risk was observed in the fully adjusted model（P-non-linear=0.008）.Moreover,the area under the ROC for MHR combined with CHA₂DS₂-VASc score was higher than for CHA₂DS₂-VASc score alone（0.700 versus 0.676,P<0.001）.Conclusions:Elevated levels of MHR have been demonstrated to be significantly correlated with IS in patients with NVAF,further enhancing the recognition accuracy of the existing CHA₂DS₂-VASc score.MHR has been identified as a novel inflammatory biomarker that can assist clinicians in the identification of patients with a heightened risk of stroke in the NVAF population.