Monocyte to high‐density lipoprotein ratio predicts clinical outcomes after acute ischemic stroke or transient ischemic attack

Abstract Aims The monocyte to high‐density lipoprotein cholesterol ratio (MHR) has emerged as a novel inflammatory biomarker of atherosclerotic cardiovascular disease. However, it has not yet been identified whether MHR can predict the long‐term prognosis of ischemic stroke. We aimed to investigate the associations of MHR levels with clinical outcomes in patients with ischemic stroke or transient ischemic attack (TIA) at 3 months and 1 year. Methods We derived data from the Third China National Stroke Registry (CNSR‐III). Enrolled patients were divided into four groups by quartiles of MHR. Multivariable Cox regression for all‐cause death and stroke recurrence and logistic regression for the poor functional outcome (modified Rankin Scale score 3–6) were used. Results Among 13,865 enrolled patients, the median MHR was 0.39 (interquartile range, 0.27–0.53). After adjustment for conventional confounding factors, the MHR level in quartile 4 was associated with an increased risk of all‐cause death (hazard ratio [HR], 1.45; 95% confidence interval [CI], 1.10–1.90), and poor functional outcome (odd ratio [OR], 1.47; 95% CI, 1.22–1.76), but not with stroke recurrence (HR, 1.02; 95% CI, 0.85–1.21) at 1 year follow‐up, compared with MHR level in quartile 1. Similar results were observed for outcomes at 3 months. The addition of MHR to a basic model including conventional factors improved predictive ability for all‐cause death and poor functional outcome validated by the C‐statistic and net reclassification index (all p < 0.05). Conclusions Elevated MHR can independently predict all‐cause death and poor functional outcome in patients with ischemic stroke or TIA.