The increase of monocyte/high-density lipoprotein cholesterol ratio precedes recurrent thrombosis in patients with APS

Abstract Objectives The monocyte-to-high-density lipoprotein cholesterol ratio (MHR) is an emerging biomarker associated with inflammation and oxidative stress, being linked to cardiovascular events in patients with chronic kidney disease or those with diabetes. Given that monocyte activation plays a central role in the pathogenesis of thrombosis in APS, and that HDL-cholesterol suppresses monocyte activation, we aimed to investigate whether MHR could serve as a predictor for recurrent thrombotic events in APS patients. Methods This retrospective longitudinal study included 107 patients diagnosed with APS at Hokkaido University Hospital. The MHR at the time of APS diagnosis was calculated and compared between patients with and without subsequent thrombotic recurrence. Among patients who experienced recurrence, MHR values were compared between two time intervals prior to the event: 0–6 and 6–36 months. Results The median [IQR] age at diagnosis was 46 [31–56] years, with a median follow-up duration of 14.4 [11.6–17.8] years. Thrombotic events recurred in 31 patients, including 22 arterial and nine venous events. The MHR at diagnosis did not significantly differ between patients with and without recurrence (5.0 [3.4–8.0] vs 5.3 [3.5–8.6], P = 0.57). However, among patients with recurrent thrombosis, average MHR values during the 0–6 months preceding the event were significantly higher than those measured 6–36 months prior (6.1 [4.3–8.3] vs 5.1 [3.8–8.6], P = 0.04). Conclusion Our findings suggest that MHR increases in the 6 months preceding recurrent thrombotic events in APS patients, indicating that it may serve as a dynamic, time-sensitive biomarker for predicting thrombotic recurrence in thrombotic APS.