Neutrophil-Lymphocyte Ratio in Cardiovascular Outcomes

The neutrophil-lymphocyte ratio (NLR) has emerged as a simple, readily available biomarker reflecting the interplay between innate inflammation and adaptive immunity. Elevated neutrophil counts indicate acute inflammatory activation, while lymphopenia may signal impaired immune regulation. Together, the NLR integrates these opposing dynamics into a single metric. In cardiovascular disease, chronic low-grade inflammation drives atherosclerotic plaque initiation, progression and rupture, while dysregulated immune responses modulate myocardial repair and remodelling. Numerous observational cohorts have demonstrated that higher NLR values predict adverse outcomes across the spectrum of cardiovascular disorders—from stable coronary artery disease and acute coronary syndromes to heart failure and stroke. Its appeal lies not only in prognostic robustness but also in cost-effectiveness, given its derivation from routine full blood counts. As a globally accessible tool, NLR holds promise for risk stratification, guiding intensification of anti-inflammatory therapies and informing personalised management in diverse healthcare settings.

Research from Nature Portfolio

Analysis of a large general-population cohort has reinforced the independent association between NLR and mortality due to heart disease. Higher NLR quartiles were linked to stepwise increases in hazard ratios for cardiovascular death, even after adjustment for traditional risk factors. Notably, the study demonstrated that elevated NLR conferred greater risk in individuals without pre-existing cardiac conditions, suggesting a role in early disease detection. Further stratification revealed stronger associations with ischaemic heart disease and cerebrovascular mortality than with cancer or respiratory causes, underscoring the specificity of NLR as a cardiovascular prognostic marker.

Neutrophil-Lymphocyte Ratio in Cardiovascular Outcomes publication trend

The graph below shows the total number of articles in neutrophil-lymphocyte ratio in cardiovascular outcomes across all publications each year (not limited to Nature Index journals).

Technical terms

Neutrophil-Lymphocyte Ratio: The quotient of neutrophil and lymphocyte counts in peripheral blood, indicating the balance between innate and adaptive immunity and serving as a marker of systemic inflammation.

Neutrophil: A type of white blood cell central to the innate immune response and early acute inflammation.

Lymphocyte: A class of white blood cell involved in adaptive immunity, including T cells and B cells.

Atherosclerosis: The process of arterial wall thickening due to lipid accumulation, fibrous elements and cellular inflammatory responses.

Hazard Ratio: A measure used in survival analysis to compare the risk of an event occurring over time between two groups.

References

1. The neutrophil–lymphocyte ratio as a risk factor for all-cause and cardiovascular mortality among individuals with diabetes: evidence from the NHANES 2003–2016. Cardiovascular Diabetology (2023).
2. Neutrophil Lymphocyte Ratio and Cardiovascular Disease Risk: A Systematic Review and Meta‐Analysis. BioMed Research International (2018).
3. Neutrophil-to-lymphocyte ratio and mortality in the United States general population. Scientific Reports (2021).
4. The neutrophil-to-lymphocyte ratio is associated with all-cause and cardiovascular mortality among individuals with hypertension. Cardiovascular Diabetology (2024).