Yi He,1 Lian Li,2 Ting Zhou,1 Hao Yang,1 Tao Liu,1 Houyuan Hu1 

1Department of Cardiovascular Medicine, Center for Circadian Metabolism and Cardiovascular Disease, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China; 2Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China

Correspondence: Houyuan Hu, Department of Cardiovascular Medicine, Center for Circadian Metabolism and Cardiovascular Disease, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China, Email houyuanhu@hotmail.com

Background: Inflammation plays an important role in the pathogenesis of coronary artery calcification (CAC). This study aims to explore the potential association between inflammation indices derived from complete blood count (CBC) and CAC, including the neutrophil to lymphocyte ratio (NLR), derived neutrophil to lymphocyte ratio (dNLR), neutrophil-monocyte to lymphocyte ratio (NMLR), systemic inflammation response index (SIRI), systemic immune-inflammation index (SII), aggregate index of systemic inflammation (AISI), platelet to lymphocyte ratio (PLR), and monocyte to lymphocyte ratio (MLR).
Methods: We systematically collected data from patients who underwent CAC scoring via cardiac CT at our hospital between July 2018 and June 2023. Patients were divided into two groups based on the presence or absence of CAC. Multivariate logistic regression analysis, smooth curve fitting, and threshold effect analysis were subsequently used to explore the potential linear or nonlinear relationships between CBC-derived inflammation indices and CAC. Subgroup analyses were conducted to examine the consistency of these findings across different subgroups.
Results: A total of 2143 participants were included in this study: the CAC group (1286 participants) and the non-CAC group (857 participants). In the four subgroups of CAC, within-group comparisons revealed that alkaline phosphatase (ALP), smoking status, and peripheral artery plaques were more prevalent in the group with CAC scores > 400. After adjusting for confounding variables, we found that the total NLR, NMLR, SIRI, and AISI were positively associated with CAC. Subsequently, we identified a nonlinear relationship between MLR and CAC, with a threshold value of 0.236. Additionally, subgroup analysis indicated that these associations remained stable across various subgroups.
Conclusion: This study indicates that the total NLR, NMLR, SIRI, and AISI are significantly positively correlated with CAC in a linear association, while MLR exhibits a nonlinear relationship with CAC. In contrast, SII, PLR, and dNLR show no significant association with CAC.

Keywords: coronary artery calcification, Agatston score, inflammation indices derived from complete blood count, association