Inflammation plays an important role in the development and progression of coronary artery disease (CAD). Hematologic and biochemical inflammatory markers have been increasingly explored as potential indicators of disease presence and severity. A retrospective study published in the Frontiers in Cardiovascular Medicine examined the association of neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and C-reactive protein to albumin ratio (CRP/ALB) with CAD severity and diagnostic performance.

The analysis included 510 patients with clinically suspected CAD who underwent coronary angiography between January 2022 and December 2024. Among them, 256 patients had angiographically confirmed CAD, while 254 served as controls without CAD. Baseline clinical and laboratory data were collected. The severity of coronary stenosis was quantified using the Gensini score. Correlations between inflammatory ratios and coronary lesion severity were evaluated using Pearson or Spearman analyses. Logistic regression identified factors associated with CAD occurrence.

NLR, MLR, and CRP/ALB levels were significantly higher in patients with CAD compared with controls (all P<0.001). Each marker demonstrated a positive correlation with Gensini scores: NLR (r=0.546), MLR (r=0.445), and CRP/ALB (r=0.500). Multivariable analysis identified male sex, hypertension, diabetes mellitus, hyperlipidemia, family history, diastolic blood pressure, triglycerides, fasting blood glucose, uric acid, NLR, MLR, and CRP/ALB as independent risk factors, while high-density lipoprotein cholesterol showed a protective association.

Combined assessment of NLR, MLR, and CRP/ALB demonstrated strong diagnostic performance for CAD (AUC 0.931), with sensitivity of 86.33% and specificity of 83.86%.

Higher inflammatory ratios were associated with greater CAD severity. Combined assessment of these markers showed stronger diagnostic performance than single markers.