Abstract
Background and Objective: The blood neutrophil/lymphocyte ratio (NLR) is a marker of peripheral inflammation, with a high NLR associated with an increased risk of cardiovascular events and poor prognosis in ischemic stroke. However, few data are available on the differential impact of the blood NLR on different silent cerebral vascular pathologies, including cerebral large-artery atherosclerosis (LAA) and cerebral small-vessel disease (CSVD), in neurologically healthy individuals.Methods: We evaluated cardiovascular risk factors, brain magnetic resonance imaging (MRI), and MR angiography of 950 individuals without any neurological diseases. The study participants were divided into three groups according to NLR tertile (low, middle, and high). The presences of extracranial (EC) and intracranial (IC) atherosclerosis were considered to indicate LAA on brain MR angiography. The presences of silent lacunar infarction (SLI) and cerebral white matter hyperintensities (WMHs) were analyzed as indices of CSVD on brain MRI.Results: In univariate analysis, the high NLR tertile group showed a high prevalence of old age, hyperlipidemia, and renal dysfunction and higher fasting glucose. Multivariable logistic regression analysis revealed that indices of LAA (EC atherosclerosis [odds ratio: 1.88; 95% confidence interval: 1.14–3.09; p = 0.01] and IC atherosclerosis [odds ratio: 1.87; 95% confidence interval: 1.15–3.06; p = 0.01]) were more prevalent in the highest NLR tertile group than in the lowest NLR tertile group after adjustment for cardiovascular risk factors. However, no significant differences were found in the prevalence of CSVD indices (SLI and WMHs) among the three NLR tertile groups.Conclusions: A high NLR is associated with the development of cerebral LAA but not CSVD.
Highlights
Vascular risk factor modification is important for future stroke prevention
Multivariable logistic regression analysis revealed that indices of large-artery atherosclerosis (LAA) (EC atherosclerosis [odds ratio: 1.88; 95% confidence interval: 1.14–3.09; p = 0.01] and IC atherosclerosis [odds ratio: 1.87; 95% confidence interval: 1.15–3.06; p = 0.01]) were more prevalent in the highest neutrophil/lymphocyte ratio (NLR) tertile group than in the lowest NLR tertile group after adjustment for cardiovascular risk factors
A high NLR is associated with the development of cerebral LAA but not cerebral small-vessel disease (CSVD)
Summary
Vascular risk factor modification is important for future stroke prevention. Ischemic stroke (IS) is caused by heterogeneous vascular pathologies in the brain [1]. Vascular inflammation promotes the development and progression of atherosclerosis and induces plaque rupture, platelet aggregation, and vascular thrombosis, which lead to increased risk of IS [8]. Recent work revealed that genetically determined circulating MCP-1 was associated with the risk of IS and LAA-type IS, suggesting that inflammation is not merely a bystander in atherosclerosis, but a predisposing factor for LAA development [13]. The blood neutrophil/lymphocyte ratio (NLR) is a marker of peripheral inflammation, with a high NLR associated with an increased risk of cardiovascular events and poor prognosis in ischemic stroke. Few data are available on the differential impact of the blood NLR on different silent cerebral vascular pathologies, including cerebral large-artery atherosclerosis (LAA) and cerebral small-vessel disease (CSVD), in neurologically healthy individuals
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