Elevated neutrophil-to-HDL cholesterol ratio (NHR) is independently associated with higher CVD prevalence in COPD patients, with each unit increase in NHR associated with higher CVD odds (OR: 1.24, 95% CI: 1.11-1.38).
Among 1033 COPD patients analyzed, 199 (19.3%) had coexisting cardiovascular disease.
Each unit increase in NHR was associated with significantly higher odds of CVD after multivariable adjustment.
Higher NHR quartiles were associated with progressively greater odds of CVD compared to the lowest quartile.
Restricted cubic spline analysis revealed a nonlinear relationship between NHR and CVD with a potential inflection point around NHR ≈ 3.4.
The association between NHR and CVD remained consistent across subgroup analyses.
NHR was proposed as an accessible composite biomarker reflecting both systemic inflammation and lipid metabolism in COPD patients with cardiovascular comorbidity.
This research examined whether a blood marker called the neutrophil-to-HDL cholesterol ratio (NHR) is linked to heart disease in people with chronic obstructive pulmonary disease (COPD). NHR is calculated by dividing the number of neutrophils (a type of white blood cell involved in inflammation) by the level of HDL cholesterol (the 'good' cholesterol) in the blood. Using data from a large U.S. national health survey collected between 2007 and 2018, the researchers studied 1,033 adults aged 40 and older with COPD, finding that about 1 in 5 (19.3%) also had cardiovascular disease such as heart failure, coronary artery disease, angina, or heart attack. The study found that higher NHR values were associated with greater odds of having cardiovascular disease. Specifically, for every one-unit increase in NHR, the odds of having cardiovascular disease increased by 24%. People in the highest quarter of NHR values had 2.6 times the odds of having cardiovascular disease compared to those with the lowest NHR values. The relationship was not perfectly linear — analysis suggested that the association may become stronger once NHR rises above approximately 3.4. These associations held up consistently even after accounting for other health and demographic factors. This research suggests that NHR, which can be calculated from standard blood tests already commonly ordered in clinical care, may be a useful marker for identifying COPD patients who are more likely to also have heart disease. Because COPD and cardiovascular disease frequently occur together and both involve inflammation and lipid abnormalities, NHR could potentially help clinicians identify higher-risk patients. However, because this was a cross-sectional study — meaning it looked at a single point in time — it cannot establish whether high NHR causes cardiovascular disease or simply reflects shared underlying processes, and further research would be needed to confirm these findings.
Zhang X, Duan J. (2026). Neutrophil-to-HDL cholesterol ratio and cardiovascular disease coexistence in COPD patients: An NHANES 2007 to 2018 analysis.. Medicine. https://doi.org/10.1097/MD.0000000000050771