Systemic Inflammation and Cardiovascular Health
Summary
Systemic inflammation underpins the pathogenesis and progression of cardiovascular disease, bridging traditional risk factors and vascular injury. Chronic low-grade inflammatory processes involve cross-talk between innate immune cells, endothelial dysfunction and lipid metabolism, contributing to atherosclerotic plaque formation, destabilisation and thrombosis. Key haematological indices derived from routine blood counts, such as the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and composite indices like the systemic immune-inflammation index, have emerged as accessible biomarkers of inflammatory burden. Mechanistic studies reveal that activated neutrophils release proteolytic enzymes and reactive oxygen species, while platelets interact with leukocytes to amplify vascular inflammation. These networks not only influence plaque evolution but also determine post-intervention outcomes and long-term prognosis. By quantifying systemic inflammatory tone, novel indices offer objective tools for risk stratification, therapeutic monitoring and the development of targeted anti-inflammatory strategies with global clinical implications.
Research from Nature Portfolio
A foundational prospective cohort study established reference ranges for white blood-cell-based inflammatory markers in a general population aged 45 and over. Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and the systemic immune-inflammation index were shown to increase with age, with sex-specific differences: platelet-to-lymphocyte ratio and SII were higher in females, while NLR was higher in males. These normative data provide critical context for interpreting inflammatory indices in clinical and research settings and underpin subsequent efforts to integrate haematological markers into cardiovascular risk models.
Systemic Inflammation and Cardiovascular Health publication trend
The graph below shows the total number of articles in systemic inflammation and cardiovascular health across all publications each year (not limited to Nature Index journals).
Technical terms
Systemic inflammation: Persistent low-grade activation of immune pathways affecting the vasculature and organs.
Neutrophil-to-lymphocyte ratio (NLR): Ratio of circulating neutrophils to lymphocytes, indicating the balance of innate and adaptive immunity.
Platelet-to-lymphocyte ratio (PLR): Ratio of platelets to lymphocytes, reflecting interaction between thrombosis and inflammation.
Systemic immune-inflammation index (SII): Composite index calculated as platelets × neutrophils ÷ lymphocytes to quantify systemic inflammatory burden.
Systemic inflammation response index (SIRI): Composite index calculated as neutrophils × monocytes ÷ lymphocytes, assessing the inflammatory response profile.
References
- Reference values for white blood-cell-based inflammatory markers in the Rotterdam Study: a population-based prospective cohort study. Scientific Reports (2018).
- Prognostic implications of systemic immune-inflammation index in myocardial infarction patients with and without diabetes: insights from the NOAFCAMI-SH registry. Cardiovascular Diabetology (2024).
- Association of systemic immune inflammatory index with all-cause and cause-specific mortality in hypertensive individuals: Results from NHANES. Frontiers in Immunology (2023).
- Systemic immune-inflammation index as a potential biomarker of cardiovascular diseases: A systematic review and meta-analysis. Frontiers in Cardiovascular Medicine (2022).
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