In COPD patients, higher monocyte-to-HDL cholesterol ratio (MHR) was independently associated with a greater prevalence of coexisting cardiovascular disease, with a graded and nonlinear pattern.
Key Findings
Results
COPD patients with coexisting CVD had significantly higher MHR levels than those without CVD.
MHR was 0.542 in the CVD group versus 0.423 in the non-CVD group (P < .001)
Total sample included 1064 COPD patients (mean age 62.8 ± 10.5 years; 56.6% female)
206 patients (19.4%) had coexisting CVD, defined as congestive heart failure, coronary heart disease, angina pectoris, or myocardial infarction
Data were drawn from NHANES 2007 to 2018, restricted to adults aged ≥40 years with physician-diagnosed COPD
Results
Each 1-unit increase in MHR was independently associated with higher odds of coexisting CVD in fully adjusted models.
Fully adjusted odds ratio (OR) = 3.27 (95% CI: 1.59–6.74; P < .001)
Model 4 (fully adjusted) controlled for sex, age, race/ethnicity, education, marital status, smoking, poverty-income ratio, hypertension, diabetes, and BMI
Four sequential logistic regression models were applied, with Model 1 unadjusted and each subsequent model adding covariate groups
The association remained statistically significant across all four models
Results
A graded association was observed across MHR quartiles, with the highest quartile showing significantly greater odds of CVD than the lowest.
P for trend < .001 across MHR quartiles
Highest quartile vs. lowest quartile: OR = 2.70 (95% CI: 1.57–4.73; P < .001)
Quartile analysis was performed in addition to treating MHR as a continuous variable
The graded pattern persisted after full covariate adjustment
Results
Restricted cubic spline analysis indicated a nonlinear positive association between MHR and CVD prevalence in COPD patients.
Restricted cubic splines were used to assess dose-response relationships between MHR and CVD
The association was characterized as nonlinear and positive
This finding complements the linear continuous-variable analysis and the quartile trend analysis
The nonlinear pattern suggests the relationship between MHR and CVD risk is not uniform across the full range of MHR values
Results
COPD patients with coexisting CVD were older, more often male, and had higher prevalence of diabetes and hypertension than those without CVD.
Median age was 68 years in the CVD group versus 61 years in the non-CVD group (P < .001)
62.1% of CVD patients were male compared to 38.9% of non-CVD patients (P < .001)
Diabetes prevalence: 43.2% in CVD group vs. 24.4% in non-CVD group (P < .001)
Hypertension prevalence: 82.5% in CVD group vs. 54.6% in non-CVD group (P < .001)
Conclusions
The cross-sectional study design precludes causal inference between MHR and CVD in COPD patients.
Authors explicitly state: 'Given the cross-sectional design, causal inference is not warranted'
Prospective studies are recommended to establish temporality and causality
The study used NHANES data, a nationally representative cross-sectional survey
The study period spanned 2007 to 2018 across multiple NHANES cycles
What This Means
This research suggests that a blood marker called the monocyte-to-HDL cholesterol ratio (MHR) — calculated by dividing the count of a type of immune cell (monocytes) by the level of 'good' cholesterol (HDL) — is linked to the presence of heart disease in people who have chronic obstructive pulmonary disease (COPD). Using data from over 1,000 U.S. adults with COPD collected between 2007 and 2018, the researchers found that patients who also had cardiovascular conditions like heart failure, coronary heart disease, or heart attacks had notably higher MHR levels than those without heart disease. This association held even after accounting for many other factors such as age, sex, smoking, diabetes, and high blood pressure.
The study found that the risk of having heart disease increased as MHR levels rose, both when looking at MHR as a continuous measurement and when dividing patients into four groups by MHR level — with those in the highest group having about 2.7 times the odds of having cardiovascular disease compared to those in the lowest group. Advanced statistical analysis also showed the relationship was not simply linear but followed a more complex pattern, meaning the increase in risk was not perfectly uniform across all MHR values.
This research suggests that MHR, which is a relatively simple and inexpensive measurement derived from routine blood tests, could potentially serve as a useful marker for identifying COPD patients who may be at higher risk of cardiovascular complications. However, because this was a cross-sectional study — meaning it looked at one point in time rather than tracking people over time — it cannot prove that higher MHR causes heart disease. Future studies that follow patients over time will be needed to determine whether this relationship is causal and whether MHR could be used to guide clinical decisions in COPD management.
Zhu C, Luan C, Chu Y. (2026). Monocyte-to-HDL cholesterol ratio and cardiovascular comorbidity in COPD: Evidence from NHANES 2007 to 2018.. Medicine. https://doi.org/10.1097/MD.0000000000050756