Combined Assessment of Established Biomarkers: Monocyte-to-HDL Ratio and Carotid IMT in Association with Acute Ischemic Stroke

Aim Inflammation is strongly linked to atherosclerosis and acute ischemic stroke (AIS). This study investigated the association of the monocyte-to-HDL ratio (MHR), an inflammatory marker, and common carotid artery intima-media thickness (CCA-IMT), a measure of atherosclerosis, both individually and in combination, with AIS.Methods This case-control study included 533 AIS patients and 218 healthy controls. MHR and CCA-IMT levels were compared between groups. Associations with AIS were analyzed using multivariate logistic regression, and discriminative performance was evaluated by receiver operating characteristic (ROC) curve analysis. The correlation between MHR and CCA-IMT was assessed using Pearson's correlation coefficient.Results MHR and CCA-IMT were significantly higher in AIS patients than controls (both P < 0.05). Both remained independently associated with AIS after adjusting for confounders. The area under the curve (AUC) was 0.719 for MHR, 0.928 for CCA-IMT, and 0.940 for their combination. MHR was positively correlated with CCA-IMT in AIS patients (r =0.386, P < 0.001).Conclusions MHR and CCA-IMT were independently associated with AIS, and their combination demonstrated high discriminatory ability in distinguishing AIS patients from healthy controls, with CCA-IMT as the dominant discriminator and MHR providing complementary inflammatory information. These findings are consistent with the proposed “inflammation-atherosclerosis axis” in AIS pathogenesis.