scholarly journals The association between triglyceride-glucose index, cardio-cerebrovascular diseases, and death in Korean adults: A retrospective study based on the NHIS-HEALS cohort

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259212
Author(s):  
Joungyoun Kim ◽  
Sang-Jun Shin ◽  
Hee-Taik Kang
Keyword(s):  
Retrospective Study ◽  
Proportional Hazards ◽  
Smoking Status ◽  
Economic Status ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Cerebrovascular Diseases ◽  
Cox Proportional Hazards ◽  
Tyg Index ◽  
All Cause Mortality

Background The triglyceride-glucose (TyG) index is a reliable indicator of insulin resistance. We aimed to investigate the TyG index in relation to cardio-cerebrovascular diseases (CCVDs and mortality. Methods This retrospective study included 114,603 subjects. The TyG index was categorized into four quartiles by sex: Q1, <8.249 and <8.063; Q2, 8.249‒<8.614 and 8.063‒<8.403; Q3, 8.614‒< 8.998 and 8.403‒<8.752; and Q4, ≥8.998 and ≥8.752, in men and women, respectively. To calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the primary outcomes (CCVDs and all-cause mortality) and secondary outcomes (cardiovascular diseases [CVDs], cerebrovascular diseases [CbVDs], CCVD-related deaths, or all-cause deaths), Cox proportional hazards regression models were adopted. Results Compared to Q1, the HRs (95% CIs) for the primary outcomes of Q2, Q3, and Q4 were 1.062 (0.981‒1.150), 1.110 (1.024−1.204), and 1.151 (1.058−1.252) in men and 1.099 (0.986−1.226), 1.046 (0.938−1.166), and 1.063 (0.954−1.184) in women, respectively, after adjusted for age, smoking status, drinking status, physical activity, body mass index, systolic blood pressure, low-density lipoprotein cholesterol, economic status, and anti-hypertensive medications. Fully adjusted HRs (95% CIs) for CVDs of Q2, Q3, and Q4 were 1.114 (0.969−1.282), 1.185 (1.031−1.363), and 1.232 (1.068−1.422) in men and 1.238 (1.017−1.508), 1.183 (0.971−1.440), and 1.238 (1.018−1.505) in women, respectively. The adjusted HRs (95% CIs) for ischemic CbVDs of Q2, Q3, and Q4 were 1.005 (0.850−1.187), 1.225 (1.041−1.441), and 1.232 (1.039−1.460) in men and 1.040 (0.821−1.316), 1.226 (0.981−1.532), and 1.312 (1.054−1.634) in women, respectively, while the TyG index was negatively associated with hemorrhagic CbVDs in women but not in men. The TyG index was not significantly associated with CCVD-related death or all-cause death in either sex. Conclusions Elevated TyG index was positively associated with the primary outcomes (CCVDs and all-cause mortality) in men and predicted higher risk of CVDs and ischemic CbVDs in both sexes.

scholarly journals Effects of Low-density Lipoprotein Cholesterol on Cardiovascular Disease and All-cause Mortality in Elderly Patients (≥75 years old)

2021 ◽  
Author(s):  
Jiaxin Yu ◽  
xiaokun liu ◽  
shuohua chen ◽  
yan liu ◽  
hongmin liu ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Cox Proportional Hazards ◽  
Cvd Risk ◽  
Proportional Hazards Regression ◽  
All Cause Mortality ◽  
Level Group ◽  
The Ideal

Abstract Background: The associations of low-density lipoprotein cholesterol (LDL-C) with cardiovascular disease (CVD) and all-cause mortality are unclear in elderly(≥75 years) Chinese individuals.Methods: A total of 3674 individuals aged 75 or older underwent medical examinations at the Kailuan Group in 2006. Participants were divided into three groups by LDL_C values: the ideal level (LDL-C <2.6 mmol/l), appropriate level (2.6 mmol/l≤ LDL-C＜3.4 mmol/l) and elevated level (LDL-C≥3.4 mmol/l) groups. CVD and all-cause mortality events were recorded during the follow-up period. The Cox proportional hazards regression model was applied to evaluate the effect of LDL-C on CVD and all-cause mortality events.Results: The average follow-up time was 9.87±3.60 years.After adjustment for confounding factors, the multivariate Cox proportional hazards regression model showed that CVD risk in the elevated group was 1.46 (95% CI, 1.08-1.97), acute myocardial infarction risk was 2.08 (95% CI, 1.26-3.44), and all-cause mortality risk in the appropriate level group and elevated group was 1.12 (95% CI, 1.00-1.25) and 1.17 (95% CI, 1.00-1.36), respectively, compared with those in the ideal level group. For every standard deviation increase in LDL-C, CVD risk increased by 10%, acute myocardial infarction risk increased by 21%, and all-cause mortality event risk increased by 4%. No association was found between elevated LDL-C levels and the risk of stroke.Conclusions: In the elderly population, elevated LDL-C levels are a risk factor for CVD and all-cause mortality.

scholarly journals The Association Between Triglyceride-Glucose Index, Cardio-Cerebrovascular Diseases, and Death in Korean Adults: A Longitudinal Study Based on the NHIS-HEALS Cohort

2021 ◽  
Author(s):  
Joungyoun Kim ◽  
Sang-jun Shin ◽  
Hee-Taik Kang
Keyword(s):  
Regression Models ◽  
Proportional Hazards ◽  
Cerebrovascular Diseases ◽  
Cox Proportional Hazards ◽  
Men And Women ◽  
Tyg Index ◽  
Proportional Hazards Regression ◽  
Hazard Ratios ◽  
Triglyceride Glucose Index ◽  
All Cause Mortality

Abstract Background: The triglyceride-glucose (TyG) index is a reliable indicator of insulin resistance. We aimed to investigate the TyG index in relation to cardio-cerebrovascular diseases (CCVDs) and mortality.Methods: This retrospective study included 114,603 subjects. The TyG index was categorized into four quartile groups by sex: Q1, <8.249 and <8.063; Q2, 8.249 ‒ <8.614 and 8.063 ‒ <8.403; Q3, 8.614 ‒ < 8.998 and 8.403 ‒ <8.752; and Q4, ≥8.998 and ≥8.752, in men and women, respectively. To calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the primary outcomes (CCVDs and all-cause mortality), Cox proportional hazards regression models were adopted.Results: Compared to Q1, fully adjusted HRs (95% CIs) for the primary outcomes of Q2, Q3, and Q4 were 1.063 (0.982‒1.152), 1.112 (1.026‒1.206), and 1.153 (1.060‒1.254) in men and 1.099 (0.986‒1.226), 1.049 (0.941‒1.169), and 1.069 (0.960‒1.190) in women, respectively. HRs (95% CIs) for cardiovascular diseases (CVDs) of Q2, Q3, and Q4 were 1.117 (0.971‒1.285), 1.191 (1.036‒1.369), and 1.237 (1.071‒1.427) in men and 1.239 (1.018‒1.509), 1.188 (0.976‒1.446), and 1.248 (1.027‒1.517) in women, respectively. Conclusions: The elevated TyG index were was positively associated with CCVDs and all-cause mortality in men and predicted the higher risk of CVDs in both sexes.

Oxidized low-density lipoprotein predicts recurrent stroke in patients with minor stroke or TIA

Neurology ◽  
2018 ◽  
Vol 91 (10) ◽  
pp. e947-e955 ◽  
Author(s):  
Anxin Wang ◽  
Jie Xu ◽  
Guojuan Chen ◽  
David Wang ◽  
S. Claiborne Johnston ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Recurrent Stroke ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Cox Proportional Hazards ◽  
Minor Stroke ◽  
Low Density ◽  
Oxidized Low Density Lipoprotein ◽  
Vascular Events ◽  
Secondary Outcomes

ObjectiveTo investigate the association between oxidized low-density lipoprotein (oxLDL) and recurrent stroke in patients with minor stroke or TIA.MethodsIn the Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events (CHANCE) trial, baseline oxLDL levels were blindly measured in plasma with the 4E6 antibody in the core laboratory. The primary outcome was any stroke within 90 days. The secondary outcomes included any stroke within 1 year and ischemic stroke and combined vascular events within 90 days and 1 year. The associations of oxLDL with recurrent stroke were analyzed by Cox proportional hazards.ResultsAmong 3,019 patients included in this study, the median (interquartile range) of oxLDL was 13.96 (6.65–28.81) μg/dL. After adjustment for conventional confounding factors, patients in the highest oxLDL quartile (≥28.81 μg/dL) had a higher risk of recurrent stroke within 90 days (hazard ratio 1.43, 95% confidence interval 1.03–1.98) compared to those in the lowest oxLDL quartile (<6.65 μg/dL). Similar results were found for secondary outcomes. We also found a J-shaped association between oxLDL and risk of each outcome. There were no significant interactions between oxLDL and low-density lipoprotein and use of dual antiplatelet, antihypertensive, antidiabetic, and statins agents.ConclusionsElevated oxLDL levels can independently predict recurrent stroke in patients with minor stroke or TIA.ClinicalTrials.gov identifier:NCT00979589.

Abstract 15837: Circulating Proneurotensin Concentrations Predict Cardiovascular Disease Events in the Community: The Framingham Heart Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
James Januzzi ◽  
Asya Lyass ◽  
Yuyin Liu ◽  
Hanna K Gaggin ◽  
April Trebnick ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Framingham Heart Study ◽  
Proportional Hazards ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Cox Proportional Hazards ◽  
Amino Acid Peptide ◽  
Risk Reclassification ◽  
Heart Study

Introduction: Neurotensin is a 13-amino acid peptide whose receptor (SORT1) is strongly linked to cardiovascular disease (CVD) development through several mechanisms, including a role in hepatic low density lipoprotein (LDL) metabolism. We measured concentrations of proneurotensin (PNT; the stable pro-fragment of neurotensin) in subjects from the Framingham Heart Study (FHS) Offspring cohort. Hypothesis: Concentrations of PNT provide incremental information for incident CV events, possibly through interactions with LDL. Methods: Blood samples from 3439 fasting subjects (mean age 59.2 years, 47.1% male) were tested for PNT (Sphingotec, Hennigsdorf, GE). The primary outcome of interest was incident hard CVD (composite of myocardial infarction [MI], stroke, and CV death). Incident hard CHD (MI and CV death) was also examined. Results: Compared to subjects in PNT quartiles 1-3, those in the highest quartile were more likely to be younger and heavier, more likely to smoke (all P <0.007), and across PNT quartiles more likely to have prevalent CVD (from 24.4% to 31.1%; P =0.003) and diabetes mellitus (from 5.5% to 13.4%; P<0.001). No association between PNT and LDL concentrations was observed. In age and sex-adjusted Cox proportional hazards models, log-PNT concentrations predicted incident hard CVD (hazard ratio [HR] = 1.24 per one standard deviation [SD] change in log-PNT; 95% confidence intervals [CI] = 1.11-1.39; P <0.001). Greatest risk for incident hard CVD was observed in log-PNT quartile 4 (HR = 1.53 per one SD change in log-PNT vs quartile 1; P =0.005). In models adjusted for standard risk factors, log-PNT remained significantly associated with incident hard CVD (HR = 1.13 per one SD change in log-PNT; 95% CI = 1.01-1.27; P = 0.03). Addition of log-PNT to the FHS Risk Score resulted in modest risk reclassification (NRI = 0.024; 95% CI=-0.0008-0.048), and in Kaplan Meier analyses, shorter time to first event was seen in higher log-PNT values (log rank P = 0.02). Similar results were found for hard CHD. We did not observe effect modification by LDL. Conclusions: Higher concentrations of PNT are associated with a greater risk of incident hard CVD and CHD in the community independent of LDL concentrations and other risk factors.

Abstract P378: Higher Non-exercise Estimated Cardiorespiratory Fitness in Midlife is Associated With Lower Risk of Cardiovascular Disease and Mortality in Later Life: The Framingham Heart Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Joowon Lee ◽  
Ramachandran S Vasan ◽  
Vanessa Xanthakis
Keyword(s):  
Cardiovascular Disease ◽  
Cardiorespiratory Fitness ◽  
Lower Risk ◽  
Proportional Hazards ◽  
Smoking Status ◽  
Health Indicators ◽  
Later Life ◽  
Cox Proportional Hazards ◽  
All Cause Mortality

Introduction: Studies have demonstrated that higher cardiorespiratory fitness (CRF) is associated with a lower risk of cardiovascular disease (CVD) and mortality. However, exercise CRF test is not routinely performed in clinical settings because it requires specialized equipment and trained personnel. Therefore, non-exercise estimated CRF (eCRF) using easily accessible health indicators in clinical practice may be a time- and cost-effective alternative for evaluating fitness. Hypothesis: We hypothesized that higher eCRF in midlife will be associated with a lower risk of CVD and all-cause mortality in later life. Methods: We evaluated 2,501 Framingham Offspring cohort participants (mean age 65 yrs., 52% women). We used a longitudinal non-exercise algorithm that includes age, sex, body mass index, waist circumference, resting heart rate, physical activity, and smoking status. We then used SAS PROC TRAJ to identify sex-specific latent patterns of eCRF (low, moderate, and high eCRF categories) between exam 2 and 8 (1979-2008). Multivariable Cox proportional hazards regression models were used to relate the long-term trajectories of eCRF to incident CVD and all-cause mortality on follow-up. Results: We identified three distinct trajectories of eCRF (Low [n=268, 10.7%] vs. moderate [n=1,273, 50.9%] vs. high [n=960, 38.4%]). Overall, 265 participants developed CVD and 429 died during 10 years of median follow-up. Participants in the “high eCRF” group were at lower risk of CVD and all-cause mortality compared to those in the “low eCRF” group, after adjustment for potential confounders ( Table ). Conclusions: Our findings suggest that lower eCRF during midlife may be a marker of risk of CVD and mortality in older adulthood.

scholarly journals Novel plasma biomarkers improve discrimination of metabolic health independent of weight

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Stephen Ellison ◽  
Jawan W. Abdulrahim ◽  
Lydia Coulter Kwee ◽  
Nathan A. Bihlmeyer ◽  
Neha Pagidipati ◽  
...  
Keyword(s):  
Particle Size ◽  
Proportional Hazards ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Cox Proportional Hazards ◽  
Metabolic Health ◽  
Plasma Biomarkers ◽  
Cox Proportional Hazards Models ◽  
Medium Particle ◽  
The Individual

AbstractWe sought to determine if novel plasma biomarkers improve traditionally defined metabolic health (MH) in predicting risk of cardiovascular disease (CVD) events irrespective of weight. Poor MH was defined in CATHGEN biorepository participants (n > 9300), a follow-up cohort (> 5600 days) comprising participants undergoing evaluation for possible ischemic heart disease. Lipoprotein subparticles, lipoprotein-insulin resistance (LP-IR), and GlycA were measured using NMR spectroscopy (n = 8385), while acylcarnitines and amino acids were measured using flow-injection, tandem mass spectrometry (n = 3592). Multivariable Cox proportional hazards models determined association of poor MH and plasma biomarkers with time-to-all-cause mortality or incident myocardial infarction. Low-density lipoprotein particle size and high-density lipoprotein, small and medium particle size (HMSP), GlycA, LP-IR, short-chain dicarboxylacylcarnitines (SCDA), and branched-chain amino acid plasma biomarkers were independently associated with CVD events after adjustment for traditionally defined MH in the overall cohort (p = 3.3 × 10−4–3.6 × 10−123), as well as within most of the individual BMI categories (p = 8.1 × 10−3–1.4 × 10−49). LP-IR, GlycA, HMSP, and SCDA improved metrics of model fit analyses beyond that of traditionally defined MH. We found that LP-IR, GlycA, HMSP, and SCDA improve traditionally defined MH models in prediction of adverse CVD events irrespective of BMI.

scholarly journals Pulmonary Sclerosing Pneumocytoma and Mortality Risk

2021 ◽  
Author(s):  
So Jeong Kim ◽  
Hye-Rin Kang ◽  
Chun Geun Lee ◽  
Seung Ho Choi ◽  
Yeon Wook Kim ◽  
...  
Keyword(s):  
Literature Review ◽  
Surgical Resection ◽  
Mortality Risk ◽  
Proportional Hazards ◽  
Smoking Status ◽  
Cox Proportional Hazards ◽  
Rank Test ◽  
Kaplan Meier ◽  
Significant Difference ◽  
All Cause Mortality

Abstract Background: Surgical resection is recommended in all patients with pulmonary sclerosing pneumocytoma (PSP). However, no comparative study has demonstrated that surgical resection leads to improved outcomes. We aimed to compare all-cause mortality between patients with PSP who underwent surgery or did not and those without PSP.Methods: Participants aged ≥18 years who had pathologically diagnosed PSP between 2001 to 2018, at 3 hospitals were included. Randomly selected (up to 1:5) age-, sex-, and smoking status-matched controls were included. Mortality was compared using Kaplan–Meier estimates and Cox proportional hazards regression models. Literature review of studies reporting PSP was also conducted.Results: This study included 107 patients with PSP (surgery:non-surgery, 80:27) and 520 matched controls. There were no cases of lymph node or distant metastasis, recurrence, or mortality from PSP. No significant difference in all-cause mortality risk was observed between the PSP surgery, PSP non-surgery, and non-PSP groups (log rank test P=0.78) (PSP surgery vs. non-PSP: adjusted hazards ratio [aHR], 1.80; 95% confidence interval [CI], 0.22-14.6; PSP non-surgery vs. non-PSP: aHR, 0.77; 95% CI, 0.15-3.86; PSP surgery vs. PSP non-surgery: aHR, 2.35; 95% CI, 0.20-28.2). In the literature review, we identified 3,469 patients with PSP from 355 studies. Only 1.33% of these patients reported metastasis, recurrence, or death.Conclusion: All-cause mortality did not differ between patients with PSP and those without, irrespective of undergoing surgery. Our study and the literature review suggest that PSP has less impact on increased mortality risk.

scholarly journals Association between low density lipoprotein cholesterol and all-cause mortality: results from the NHANES 1999–2014

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ya Liu ◽  
Fubin Liu ◽  
Liwen Zhang ◽  
Junxian Li ◽  
Wenjuan Kang ◽  
...  
Keyword(s):  
Reference Group ◽  
Smoking Status ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Low Density ◽  
Low Density Lipoprotein Cholesterol ◽  
Health And Nutrition ◽  
All Cause Mortality ◽  
Adjusted Model

AbstractThe association between low density lipoprotein cholesterol (LDL-C) and all-cause mortality has been examined in many studies. However, inconsistent results and limitations still exist. We used the 1999–2014 National Health and Nutrition Examination Survey (NHANES) data with 19,034 people to assess the association between LDL-C level and all-cause mortality. All participants were followed up until 2015 except those younger than 18 years old, after excluding those who died within three years of follow-up, a total of 1619 deaths among 19,034 people were included in the analysis. In the age-adjusted model (model 1), it was found that the lowest LDL-C group had a higher risk of all-cause mortality (HR 1.708 [1.432–2.037]) than LDL-C 100–129 mg/dL as a reference group. The crude-adjusted model (model 2) suggests that people with the lowest level of LDL-C had 1.600 (95% CI [1.325–1.932]) times the odds compared with the reference group, after adjusting for age, sex, race, marital status, education level, smoking status, body mass index (BMI). In the fully-adjusted model (model 3), people with the lowest level of LDL-C had 1.373 (95% CI [1.130–1.668]) times the odds compared with the reference group, after additionally adjusting for hypertension, diabetes, cardiovascular disease, cancer based on model 2. The results from restricted cubic spine (RCS) curve showed that when the LDL-C concentration (130 mg/dL) was used as the reference, there is a U-shaped relationship between LDL-C level and all-cause mortality. In conclusion, we found that low level of LDL-C is associated with higher risk of all-cause mortality. The observed association persisted after adjusting for potential confounders. Further studies are warranted to determine the causal relationship between LDL-C level and all-cause mortality.

scholarly journals High School Quality and 56-Year All-Cause Mortality Risk Across Race and Ethnicity

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 505-506
Author(s):  
Dominika Seblova ◽  
Kelly Peters ◽  
Susan Lapham ◽  
Laura Zahodne ◽  
Tara Gruenewald ◽  
...  
Keyword(s):  
High School ◽  
Mortality Risk ◽  
Race And Ethnicity ◽  
Proportional Hazards ◽  
School Quality ◽  
Cox Proportional Hazards ◽  
School Level ◽  
Lower Mortality ◽  
All Cause Mortality ◽  
Race Ethnicity

Abstract Having more years of education is independently associated with lower mortality, but it is unclear whether other attributes of schooling matter. We examined the association of high school quality and all-cause mortality across race/ethnicity. In 1960, about 5% of US high schools participated in Project Talent (PT), which collected information about students and their schools. Over 21,000 PT respondents were followed for mortality into their eighth decade of life using the National Death Index. A school quality factor, capturing term length, class size, and teacher qualifications, was used as the main predictor. First, we estimated overall and sex-stratified Cox proportional hazards models with standard errors clustered at the school level, adjusting for age, sex, composite measure of parental socioeconomic status, and 1960 cognitive ability. Second, we added an interaction between school quality and race/ethnicity. Among this diverse cohort (60% non-Hispanic Whites, 23% non-Hispanic Blacks, 7% Hispanics, 10% classified as another race/s) there were 3,476 deaths (16.5%). School quality was highest for Hispanic respondents and lowest for non-Hispanic Blacks. Non-Hispanic Blacks also had the highest mortality risk. In the whole sample, school quality was not associated with mortality risk. However, higher school quality was associated with lower mortality among those classified as another race/s (HR 0.75, 95% CI: 0.56-0.99). For non-Hispanic Blacks and Whites, the HR point estimates were unreliable, but suggest that higher school quality is associated with increased mortality. Future work will disentangle these differences in association of school quality across race/ethnicity and examine cause-specific mortality.

scholarly journals Pre-diagnosis neutrophil-to-lymphocyte ratio and mortality in individuals who develop lung cancer

2021 ◽  
Author(s):  
Laurie Grieshober ◽  
Stefan Graw ◽  
Matt J. Barnett ◽  
Gary E. Goodman ◽  
Chu Chen ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Proportional Hazards ◽  
Smoking Status ◽  
Cox Proportional Hazards ◽  
Neutrophil To Lymphocyte Ratio ◽  
Blood Draw ◽  
Lymphocyte Ratio ◽  
Cox Proportional Hazards Models ◽  
Inflammatory Profile ◽  
Heavy Smokers

Abstract Purpose The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation that has been reported to be associated with survival after chronic disease diagnoses, including lung cancer. We hypothesized that the inflammatory profile reflected by pre-diagnosis NLR, rather than the well-studied pre-treatment NLR at diagnosis, may be associated with increased mortality after lung cancer is diagnosed in high-risk heavy smokers. Methods We examined associations between pre-diagnosis methylation-derived NLR (mdNLR) and lung cancer-specific and all-cause mortality in 279 non-small lung cancer (NSCLC) and 81 small cell lung cancer (SCLC) cases from the β-Carotene and Retinol Efficacy Trial (CARET). Cox proportional hazards models were adjusted for age, sex, smoking status, pack years, and time between blood draw and diagnosis, and stratified by stage of disease. Models were run separately by histotype. Results Among SCLC cases, those with pre-diagnosis mdNLR in the highest quartile had 2.5-fold increased mortality compared to those in the lowest quartile. For each unit increase in pre-diagnosis mdNLR, we observed 22–23% increased mortality (SCLC-specific hazard ratio [HR] = 1.23, 95% confidence interval [CI]: 1.02, 1.48; all-cause HR = 1.22, 95% CI 1.01, 1.46). SCLC associations were strongest for current smokers at blood draw (Interaction Ps = 0.03). Increasing mdNLR was not associated with mortality among NSCLC overall, nor within adenocarcinoma (N = 148) or squamous cell carcinoma (N = 115) case groups. Conclusion Our findings suggest that increased mdNLR, representing a systemic inflammatory profile on average 4.5 years before a SCLC diagnosis, may be associated with mortality in heavy smokers who go on to develop SCLC but not NSCLC.

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