Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://cr.elmerpub.com

Original Article

Volume 16, Number 2, April 2025, pages 110-119

A Clinical Retrospective Study on the Combined Use of Monocyte-to-Lymphocyte Ratio and Triglyceride-Glucose Index to Predict the Severity of Coronary Artery Disease

Figure 1. ROC curve comparing the predictive performance of MLR, TyG index, their combination (MLR and TyG index), and the Framingham risk model for CAD severity. CAD: coronary artery disease; MLR: monocyte-to-lymphocyte ratio; ROC: receiver operating characteristic; TyG: triglyceride-glucose.

Figure 2. Differences in MLR and TyG index across CAD severity groups. Significant differences were observed in MLR (a) and TyG index (b) across CAD severity groups, with the combined model (c) showing the most pronounced distinction. CAD: coronary artery disease; MLR: monocyte-to-lymphocyte ratio; TyG: triglyceride-glucose.

Figure 3. The AUC values with 95% CI for subgroups (male, female, diabetes, no diabetes, hypertension, and no hypertension) are shown. Significant differences in AUC were observed between men and women (P < 0.05), and between diabetic and non-diabetic patients (P < 0.05). No significant differences in sensitivity and specificity were found between subgroups (not shown). Orange dots represent AUC values, and red bars represent the 95% CI. AUC: area under the curve; CI: confidence interval.

**Table 1.** Baseline Characteristics of the Study Population
Variables	Control group (n = 223)	CAD group (n = 455)	P value
BMI: body mass index; BUN: blood urea nitrogen; CCR: creatinine clearance rate; DM: diabetes mellitus; FPG: fasting plasma glucose; HDL: high-density lipoprotein cholesterol; HGB: hemoglobin; HT: hypertension; LDL: low-density lipoprotein cholesterol; MLR: monocyte-to-lymphocyte ratio; NLR: neutrophil-to-lymphocyte ratio; TC: total cholesterol; TG: triglycerides; TyG: triglyceride-glucose.
Age (years)	55.94 ± 9.03	63.33 ± 9.32	< 0.01
Gender, male (%)	70 (31.4%)	245 (53.8%)	< 0.01
BMI (kg/m²)	24.79 ± 2.67	24.90 ± 3.09	0.66
Smoking, n (%)	69 (30.9%)	244 (53.6%)	< 0.01
DM, n (%)	27 (12.1%)	146 (32.1%)	< 0.01
HT, n (%)	109 (48.9%)	343 (75.4%)	< 0.01
HGB (g/L)	136.3 ± 15.41	135.39 ± 15.13	0.45
Platelet (× 10⁹/L)	223.51 ± 52.98	209.07 ± 55.07	0.02
Leukocyte (× 10⁹/L)	5.89 (4.95 - 6.96)	6.48 (5.2 - 7.63)	< 0.01
Neutrophil (× 10⁹/L)	3.59 (2.83 - 4.31)	4.27 (3.4 - 5.34)	< 0.01
Monocyte (× 10⁹/L)	2.92 (2.36 - 3.41)	4.03 (3.17 - 4.89)	< 0.01
Lymphocyte (× 10⁹/L)	2.04 (1.59 - 2.50)	1.78 (1.40 - 2.24)	< 0.01
FPG (mmol/L)	5.25 (4.63 - 5.91)	6.18 (5.3 - 7.11)	< 0.01
TC (mmol/L)	4.84 (4.10 - 5.58)	4.99 (4.23 - 4.75)	0.18
TG (mmol/L)	1.28 (0.99 - 1.94)	1.75 (1.23 - 2.35)	< 0.01
LDL (mmol/L)	2.67 (2.12 - 3.24)	2.74 (2.23 - 3.42)	0.23
HDL (mmol/L)	1.17 (1.02 - 1.37)	1.13 (0.92 - 1.29)	0.02
BUN (mmol/L)	4.94 ± 1.02	5.13 ± 1.10	0.35
CCR (µmol/L)	71.05 ± 15.32	67.89 ± 16.02	0.13
MLR	1.49 (1.22 - 1.77)	2.20 (1.62 - 3.03)	< 0.01
NLR	1.79 (1.35 - 2.28)	2.44 (1.74 - 3.37)	< 0.01
TyG index	4.67 (4.49 - 4.85)	4.85 (4.72 - 5.04)	< 0.01

Table 1. Baseline Characteristics of the Study Population

Variables

Control group (n = 223)

CAD group (n = 455)

P value

BMI: body mass index; BUN: blood urea nitrogen; CCR: creatinine clearance rate; DM: diabetes mellitus; FPG: fasting plasma glucose; HDL: high-density lipoprotein cholesterol; HGB: hemoglobin; HT: hypertension; LDL: low-density lipoprotein cholesterol; MLR: monocyte-to-lymphocyte ratio; NLR: neutrophil-to-lymphocyte ratio; TC: total cholesterol; TG: triglycerides; TyG: triglyceride-glucose.

Age (years)

55.94 ± 9.03

63.33 ± 9.32

< 0.01

Gender, male (%)

70 (31.4%)

245 (53.8%)

< 0.01

BMI (kg/m²)

24.79 ± 2.67

24.90 ± 3.09

0.66

Smoking, n (%)

69 (30.9%)

244 (53.6%)

< 0.01

DM, n (%)

27 (12.1%)

146 (32.1%)

< 0.01

HT, n (%)

109 (48.9%)

343 (75.4%)

< 0.01

HGB (g/L)

136.3 ± 15.41

135.39 ± 15.13

0.45

Platelet (× 10⁹/L)

223.51 ± 52.98

209.07 ± 55.07

0.02

Leukocyte (× 10⁹/L)

5.89 (4.95 - 6.96)

6.48 (5.2 - 7.63)

< 0.01

Neutrophil (× 10⁹/L)

3.59 (2.83 - 4.31)

4.27 (3.4 - 5.34)

< 0.01

Monocyte (× 10⁹/L)

2.92 (2.36 - 3.41)

4.03 (3.17 - 4.89)

< 0.01

Lymphocyte (× 10⁹/L)

2.04 (1.59 - 2.50)

1.78 (1.40 - 2.24)

< 0.01

FPG (mmol/L)

5.25 (4.63 - 5.91)

6.18 (5.3 - 7.11)

< 0.01

TC (mmol/L)

4.84 (4.10 - 5.58)

4.99 (4.23 - 4.75)

0.18

TG (mmol/L)

1.28 (0.99 - 1.94)

1.75 (1.23 - 2.35)

< 0.01

LDL (mmol/L)

2.67 (2.12 - 3.24)

2.74 (2.23 - 3.42)

0.23

HDL (mmol/L)

1.17 (1.02 - 1.37)

1.13 (0.92 - 1.29)

0.02

BUN (mmol/L)

4.94 ± 1.02

5.13 ± 1.10

0.35

CCR (µmol/L)

71.05 ± 15.32

67.89 ± 16.02

0.13

MLR

1.49 (1.22 - 1.77)

2.20 (1.62 - 3.03)

< 0.01

NLR

1.79 (1.35 - 2.28)

2.44 (1.74 - 3.37)

< 0.01

TyG index

4.67 (4.49 - 4.85)

4.85 (4.72 - 5.04)

< 0.01

**Table 2.** Spearman Correlation Analysis of MLR and TyG Index With CAD and Its Severity
Correlation indicator	MLR	TyG index
CAD: coronary artery disease; MLR: monocyte-to-lymphocyte ratio; SYNTAX: Synergy Between PCI With Taxus and Cardiac Surgery score; TyG: triglyceride-glucose.
CAD	0.446	<0.01	0.361	<0.01
SYNTAX	0.578	<0.01	0.515	<0.01

Table 2. Spearman Correlation Analysis of MLR and TyG Index With CAD and Its Severity

Correlation indicator

MLR

TyG index

CAD: coronary artery disease; MLR: monocyte-to-lymphocyte ratio; SYNTAX: Synergy Between PCI With Taxus and Cardiac Surgery score; TyG: triglyceride-glucose.

CAD

0.446

<0.01

0.361

<0.01

SYNTAX

0.578

<0.01

0.515

<0.01

**Table 3.** Multivariate Logistic Regression Analysis of Factors Associated With CAD
Variable	β	Wald	P value	OR	95% CI
Multivariate logistic regression analysis. Wald test used for significance evaluation. P < 0.05, *P < 0.01. BMI: body mass index; CAD: coronary artery disease; CI: confidence interval; DM: diabetes mellitus; FPG: fasting plasma glucose; HDL: high-density lipoprotein cholesterol; HGB: hemoglobin; HT: hypertension; LDL: low-density lipoprotein cholesterol; MLR: monocyte-to-lymphocyte ratio; NLR: neutrophil-to-lymphocyte ratio; OR: odds ratio; SYNTAX: Synergy Between PCI With Taxus and Cardiac Surgery score; TyG: triglyceride-glucose; TC: total cholesterol; TG: triglycerides; TyG: triglyceride-glucose.
Age	0.06	17.92	0.002**	1.05	1.03 - 1.09
Male	0.32	1.85	0.174	1.38	0.87 - 2.18
BMI	0.07	2.53	0.112	1.08	0.98 - 1.19
Smoking	0.63	6.14	0.013*	1.86	1.14 - 3.05
DM	1.00	8.54	0.024*	2.72	1.35 - 5.32
HT	0.37	3.48	0.062	1.45	0.98 - 2.15
HGB	-0.03	6.34	0.012*	0.97	0.95 - 0.99
Platelet	0.01	0.43	0.510	1.01	0.99 - 1.02
Leukocyte	0.15	4.12	0.042*	1.16	1.01 - 1.33
Neutrophil	0.17	5.35	0.021*	1.19	1.03 - 1.38
Monocyte	0.14	3.84	0.050	1.15	1.00 - 1.33
Lymphocyte	-0.11	2.90	0.089	0.90	0.79 - 1.30
FPG	0.89	17.69	0.015*	1.12	1.61 - 3.67
TC	0.08	1.25	0.264	1.08	0.95 - 1.22
TG	0.39	11.43	0.001**	1.48	1.22 - 1.80
LDL	0.06	0.53	0.470	1.06	0.89 - 1.27
HDL	-0.11	0.99	0.320	0.89	0.70 - 1.12
NLR	0.42	6.68	0.010**	1.52	1.10 - 2.10
MLR	0.76	10.23	0.001**	2.15	1.40 - 3.28
TyG index	0.56	12.56	0.001**	1.75	1.30 - 2.36
SYNTAX	0.82	15.12	0.001**	2.27	1.57 - 3.28

Table 3. Multivariate Logistic Regression Analysis of Factors Associated With CAD

Variable

Wald

P value

95% CI

Multivariate logistic regression analysis. Wald test used for significance evaluation. *P < 0.05, **P < 0.01. BMI: body mass index; CAD: coronary artery disease; CI: confidence interval; DM: diabetes mellitus; FPG: fasting plasma glucose; HDL: high-density lipoprotein cholesterol; HGB: hemoglobin; HT: hypertension; LDL: low-density lipoprotein cholesterol; MLR: monocyte-to-lymphocyte ratio; NLR: neutrophil-to-lymphocyte ratio; OR: odds ratio; SYNTAX: Synergy Between PCI With Taxus and Cardiac Surgery score; TyG: triglyceride-glucose; TC: total cholesterol; TG: triglycerides; TyG: triglyceride-glucose.

Age

0.06

17.92

0.002**

1.05

1.03 - 1.09

Male

0.32

1.85

0.174

1.38

0.87 - 2.18

BMI

0.07

2.53

0.112

1.08

0.98 - 1.19

Smoking

0.63

6.14

0.013*

1.86

1.14 - 3.05

1.00

8.54

0.024*

2.72

1.35 - 5.32

0.37

3.48

0.062

1.45

0.98 - 2.15

HGB

-0.03

6.34

0.012*

0.97

0.95 - 0.99

Platelet

0.01

0.43

0.510

1.01

0.99 - 1.02

Leukocyte

0.15

4.12

0.042*

1.16

1.01 - 1.33

Neutrophil

0.17

5.35

0.021*

1.19

1.03 - 1.38

Monocyte

0.14

3.84

0.050

1.15

1.00 - 1.33

Lymphocyte

-0.11

2.90

0.089

0.90

0.79 - 1.30

FPG

0.89

17.69

0.015*

1.12

1.61 - 3.67

0.08

1.25

0.264

1.08

0.95 - 1.22

0.39

11.43

0.001**

1.48

1.22 - 1.80

LDL

0.06

0.53

0.470

1.06

0.89 - 1.27

HDL

-0.11

0.99

0.320

0.89

0.70 - 1.12

NLR

0.42

6.68

0.010**

1.52

1.10 - 2.10

MLR

0.76

10.23

0.001**

2.15

1.40 - 3.28

TyG index

0.56

12.56

0.001**

1.75

1.30 - 2.36

SYNTAX

0.82

15.12

0.001**

2.27

1.57 - 3.28

**Table 4.** Association of MLR and TyG Index With CAD Severity
CAD severity	MLR	TyG index
^aAdjustment for gender, smoking, hypertension, diabetes, TC, TG, HDL-C, LDL-C. CAD: coronary artery disease; CI: confidence interval; HDL: high-density lipoprotein cholesterol; LDL: low-density lipoprotein cholesterol; MLR: monocyte-to-lymphocyte ratio; TyG: triglyceride-glucose; OR: odds ratio; TC: total cholesterol; TG: triglycerides.
Mild CAD	0.90 (0.53 - 1.28)	< 0.001	2.13 (1.18 - 3.09)	< 0.001
Moderate CAD	1.93 (1.47 - 2.38)	< 0.001	3.03 (1.66 - 4.39)	< 0.001
Severe CAD	2.68 (2.18 - 3.18)	< 0.001	4.30 (2.64 - 5.74)	< 0.001

Table 4. Association of MLR and TyG Index With CAD Severity

CAD severity

MLR

TyG index

OR (95% CI)^a

^aAdjustment for gender, smoking, hypertension, diabetes, TC, TG, HDL-C, LDL-C. CAD: coronary artery disease; CI: confidence interval; HDL: high-density lipoprotein cholesterol; LDL: low-density lipoprotein cholesterol; MLR: monocyte-to-lymphocyte ratio; TyG: triglyceride-glucose; OR: odds ratio; TC: total cholesterol; TG: triglycerides.

Mild CAD

0.90 (0.53 - 1.28)

< 0.001

2.13 (1.18 - 3.09)

< 0.001

Moderate CAD

1.93 (1.47 - 2.38)

< 0.001

3.03 (1.66 - 4.39)

< 0.001

Severe CAD

2.68 (2.18 - 3.18)

< 0.001

4.30 (2.64 - 5.74)

< 0.001