With changes in lifestyle and dietary structure, the disease burden of atherosclerotic cardiovascular disease (ASCVD) in China has been increasing and shows a trend of younger onset. Dyslipidemia and inflammatory reactions play a key role in the disease progression. However, both lipid markers and inflammatory markers are multidimensional and interrelated, making it challenging to directly assess their relationship. Therefore, this study used canonical correlation analysis (CCA) to deconstruct the correlation between the two sets of variables, with the aim of providing new insights into the prevention and intervention of ASCVD.

To explore the canonical correlations between lipid ratios and inflammatory markers in individuals at risk of cardiovascular disease.

This study selected 7 518 individuals who underwent health check-ups at the Health Management Center, Tianjin Medical University General Hospital in 2020. A questionnaire was used to collect sociodemographic information, lifestyle, medical history, and family history of cardiovascular disease. Anthropometric measurements included height, weight, waist circumference (WC), and blood pressure, and BMI was calculated. Fasting venous blood was drawn for biochemical tests. Based on the China-PAR model for assessing the 10-year risk of ASCVD, the subjects were divided into three groups: low-risk (n=4 718), medium-risk (n=1 575), and high-risk (n=1 225). CCA was used to explore the correlation between lipid ratios[total cholesterol (TC) /high-density lipoprotein cholesterol (HDL-C), triglyceride (TG) /HDL-C, low-density lipoprotein cholesterol (LDL-C) /HDL-C] and inflammatory markers[neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-monocyte ratio (NMR), lymphocyte-to-monocyte ratio (LMR), monocyte-to-HDL-C ratio (MHR), C-reactive protein (CRP) ].

A total of 7 518 subjects were included, with a median age of 49.00 (40.00, 57.00) years and a median 10-year ASCVD risk of 3.22% (1.02%, 7.51%) ; 4 133 (54.97%) were male and 3 385 (45.03%) were female. There were statistically significant differences in TG/HDL-C, TC/HDL-C, LDL-C/HDL-C, NLR, NMR, LMR, MHR, and CRP among the different 10-year ASCVD risk groups (P<0.05). CCA identified three pairs of canonical variables to replace the original variables to study the correlation between lipid ratios and inflammatory markers, all of which indicated a correlation between the two (r=0.569, 0.100, 0.049; P<0.05). In the first pair of standardized canonical variables, LDL-C/HDL-C was positively correlated with MHR within a certain range; in the second pair, TC/HDL-C was positively correlated with CRP. Stratified analysis showed that in the low-risk group, all three pairs of canonical variables indicated a correlation between lipid ratios and inflammatory markers (r=0.573, 0.110, 0.060; P<0.05). In the medium-risk group, the first two pairs of canonical variables indicated a correlation (r=0.552, 0.142; P<0.05). In the high-risk group, the first two pairs of canonical variables indicated a correlation (r=0.496, 0.135; P<0.05). In the low-risk group, in the first pair of standardized canonical variables, LDL-C/HDL-C was positively correlated with MHR within a certain range; in the second pair, TC/HDL-C was positively correlated with LMR within a certain range. In the medium-risk group, in the first pair of standardized canonical variables, LDL-C/HDL-C was positively correlated with MHR within a certain range; in the second pair, TC/HDL-C was positively correlated with LMR within a certain range. In the high-risk group, in the first pair of standardized canonical variables, TG/HDL-C was positively correlated with MHR within a certain range; in the second pair, TC/HDL-C was negatively correlated with NLR within a certain range.

Lipid ratios and inflammatory markers are canonically correlated, with a stronger correlation between LDL-C/HDL-C and MHR. LDL-C/HDL-C combines LDL-C and HDL-C to reflect their level changes and better indicates the lipid metabolism level in the body. MHR integrates the pro-inflammatory effect of monocytes and the anti-inflammatory effect of HDL-C, offering a greater advantage for predicting ASCVD. Future research needs more large-scale prospective studies to assess and validate their predictive performance, with the hope of providing new ideas for the assessment and intervention of ASCVD.