This study aims to explore the correlation between the monocyte/high-density lipoprotein ratio (MHR), red blood cell (RBC), hemoglobin (Hb) levels, and lower limb atherosclerosis (AS) in patients diagnosed with essential hypertension (EH). A total of 310 EH patients admitted to the General Medical Department of the Second Affiliated Hospital of Guilin Medical College between July 2021 and December 2022 were selected for this analysis. The patients were categorized into four groups based on the severity of lower limb AS: the AS1+EH group (simple EH) included 90 patients; the AS2+EH group (EH with intimal thickening of the lower extremity arteries) comprised 42 patients; the AS3+EH group (EH with lower extremity arterial plaques) consisted of 90 patients; and the AS4+EH group (EH with lower extremity arterial stenosis) included 88 patients. Age, history of coronary heart disease, white blood cells (WBC), RBC, Hb, monocytes, platelets, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), indirect bilirubin (IBIL), and MHR were all statistically significant across the four groups. Specifically, the counts of RBC and Hb in the AS1+EH, AS2+EH, AS3+EH, and AS4+EH groups exhibited a decreasing trend, while age showed an increasing trend. WBC, monocytes, platelets, and MHR demonstrated an overall increasing trend; however, a decrease was observed in the AS3+EH group compared to the AS1+EH group (P < 0.05). In contrast, no statistically significant differences were found in gender, direct bilirubin (DBIL), total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) (P > 0.05).Spearman rank correlation analysis indicated that in patients with lower limb AS, MHR exhibited a positive correlation with WBC, monocytes, platelets, and TG. Conversely, MHR showed a negative correlation with RBC, TC, HDL, and LDL. Additionally, MHR was correlated with age, Hb, ALT, AST, and TBIL; however, DBIL and IBIL were not found to be related. Multivariate logistic regression analysis indicated that increasing age, along with decreasing RBC and Hb levels, are risk factors for grades 3 to 4 lower AS in patients with EH. Additionally, an elevated MHR was identified as a risk factor specifically for grade 4 lower limb AS in these patients. The parameters MHR, RBC, and Hb are correlated with the severity of lower limb AS in EH patients. Notably, RBC and Hb levels decline as the severity of lower limb AS increases, particularly in patients classified with grades 3 to 4. Conversely, MHR levels rise with increasing severity of lower extremity AS, primarily observed in patients with grade 4.

Lei Wei, Yu Le, Fan Xianying, Huang Baohua. Correlation of the Monocyte/High-Density Lipoprotein Ratio, Red Blood Cell, Hemoglobin and Combined Lower Extremity Atherosclerosis in Patients with Essential Hypertension. International Journal of Frontiers in Medicine (2024), Vol. 6, Issue 9: 45-54. https://doi.org/10.25236/IJFM.2024.060907.

[1] China Cardiovascular Health and Disease Report Writing Group. Summary of the China Cardiovascular Health and Disease Report 2021[J]. Chinese Journal of Circulation, 2022, 37(6): 553-578.

[2] Jankowska-Polanska B, Jez K, Swiatoniowska-Lonc N, et al. Influence of frailty syndrome on compliance with therapeutic recommendations by elderly patients with hypertension[J] . Eur J Prevent Cardiol, 2021, 18(3):224-225.

[3] Mok Y, Ishigami J, Lutsey P L, et al. Peripheral artery disease and subsequent risk of infectious disease in older individuals: The Aric study[J].Mayo Clin Proc, 2022, 97(11): 2065-2075.

[4] Yang Li. Application of multislice spiral CT angiography in the diagnosis of arterial stenosis and occlusive disease of both lower limbs[J]. Imaging Research and Medical Application, 2022, 6(2): 128-130.

[5] Jiang M, Yang J M, Zou H Y Y, et al. Monocyte-tohigh-density lipoprotein-cholesterol ratio(MHR) and the risk of all-cause and cardiovascular mortality:a nationwide cohort study in the United States[J]. Lipids Health Dis, 2022, 21(1):30. 

[6] Ohhawa R, Low H, Mukhamedova N, et al.Cholesterol transport between red blood cells and lipoproteins contributes to cholesterol metabolism in blood[J].J Lipid Res, 2020, 61(12): 1577-1588.

[7] Huang Jianyu, Ma Jun, Guo Yan, et al. Peripheral hemoglobin level is significantly associated with the degree of atherosclerosis in hypertensive patients[J]. Journal of Southern Medical University, 2020, (2):240-245.

[8] Committee on Revision of Chinese Hypertension Prevention and Control Guidelines. China hypertension prevention and treatment guidelines 2018 revision [J]. Cardiovascular and Cerebrovascular Disease Prevention and Control, 2019, 19(1):1-44. 

[9] Xu Chuangying, Cui Guiyun. Predictive value of monocyte to high-density lipoprotein cholesterol ratio in acute ischemic stroke[J]. China Clinical Medicine, 2021, 28(5): 776-781.

[10] Liu Mingming. Clinical phenotype of familial hypercholesterolemia and the mechanism of SORBS2 gene promoting atherosclerosis[D]. Beijing: Peking Union Medical College, 2022.

[11] Huang Xingjie, Xia Zhonghua, Pei Fang, et al. Relationship between changes in monocyte count/high density lipoprotein ratio and combined carotid atherosclerosis in patients with essential hypertension[J]. Guangxi Medicine, 2020, 42(13):1621-1624.

[12] Ding Yan, Pan Wei, Wang Feng, et al. Diagnostic value of monocyte/high-density lipoprotein cholesterol ratio for lower extremity arterial stenosis[J]. Chinese Journal of Atherosclerosis, 2022, 30(3): 237-242.

[13] Tu Zhenxing, Wang Yan, Li Ye, et al. Correlation between neutrophil/lymphocyte ratio, monocyte/high density lipoprotein ratio and lower limb arteriopathy in patients with type 2 diabetes mellitus [J]. Clinical rational use of medicine, 2021, 14(5):38-41.

[14] Li Zhichao, Meng Yu, Duan Huiran, et al. Correlation analysis of monocyte/high-density lipoprotein ratio and type 2 diabetes mellitus combined with lower limb atherosclerotic occlusive disease[J]. Chinese Journal of Atherosclerosis, 2020, 28(3):242-246.

[15] Ohkawa R, Low H, Mukhamedova N, et al. Cholesterol transport between red blood cells and lipoproteins contributes to cholesterol metabolism in blood[J].J Lipid Res, 2020, 61(12):1577-1588.

[16] Chen JJ, Wang DD, Wang FG, et al.Exendin-4 inhibits structural remodeling and improves Ca2+ homeostasis in rats with heart failure via the GLP-1 receptor through the eNOS/cGMP /PKG pathway[J].Peptides, 2017, 90:69-77.

[17] Mozos I. Mechanisms linking red blood cell disorders and cardiovascular diseases[J]. Biomed Res Int, 2015, 2015: 682054.

[18] Turpin C, Catan A, Meilhac O, et al. Erythrocytes: Central Actors in Multiple Scenes of Atherosclerosis[J].Int J Mol Sci, 2021, 22(11):5843.DOI:10.3390/ijms22115843.

[19] Hong YJ, Jeong MH, Choi YH, et al. Relation between anemia and vulnerable coronary plaque components in patients with acute coronary syndrome: virtual histology-intravascular ultrasound analysis[J].J Korean Med Sci, 2012, 27(4):370-376

[20] Delbosc S, Bayles RG, Laschet J, et al. Erythrocyte efferocytosis by the arterial wall promotes oxidation in early stage atheroma in humans [J]. Front Cardiovasc Med, 2017, 4:43.

[21] Polizio AH, Park E, Walsh K.Clonal Hematopoiesis: Connecting Aging and inflammation in atherosclerosis[J].Curr Atherosclero Rep, 2023, 25(3):105-111. 

[22] Patrick Lacolley, Veronique Regnault, Alberto P Avoli. Smooth muscle cell and arterial aging: Basic and clinical aspects[J].Cardiovascular Research, 2018, 114(4):513-528.

[23] Zhang Cuntai, Tao Jun, Tian Xiaoli, et al. Chinese expert consensus on clinical assessment and intervention of vascular senescence 2018[J]. Chinese Geriatrics Research Electronic Miscellaneous, 2019, 6(1):1-8.

[24] Liu Xiaochen, Li Yuanmin. Research progress on the relationship between damaged erythrocytes and atherosclerosis[J]. Chinese Cardiovascular Journal, 2024, 29(2):183-187.