Elevated monocyte-to-HDL ratio associated with stroke predisposition in U.S. adultsHigh monocyte-to-HDL cholesterol ratio linked to higher stroke risk in adults

Frontiers in Medicine Published April 17, 2026 DOI ↗ Editorial oversight: Dr. Ji-eun Park, MD · Brain, Mind & Pain

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Key Takeaway

Note an elevated monocyte-to-HDL ratio is associated with stroke predisposition in U.S. adults, but causation is not established.

This cross-sectional study used data from the 1999–2020 National Health and Nutrition Examination Survey (NHANES) involving 43,321 U.S. adults. The population included 1,583 individuals with physician-diagnosed stroke and a non-stroke comparator group refined to 4,719 subjects following propensity score matching. The exposure was the monocyte-to-high-density lipoprotein cholesterol ratio (MHR).

The primary outcome was stroke risk. In the fully adjusted multivariable model, an elevated MHR demonstrated a statistically significant association with stroke predisposition. The effect size was an odds ratio (OR) of 1.517, with a 95% confidence interval (CI) of 1.096–2.099. No specific absolute numbers for the outcome were reported.

Safety and tolerability data, including adverse events, serious adverse events, and discontinuations, were not reported. The study design is observational, and the authors note the finding represents an association, not causation.

Key limitations include the cross-sectional design, which cannot establish temporality, and the reliance on physician-diagnosed stroke. The authors state that further prospective studies are required to validate its temporal relationship and clinical applicability.

While the statistically significant association was robust across demographic and clinical strata in subgroup analyses, the practice relevance is not established. This finding may inform future research but should not guide clinical decisions without prospective validation.

This research looked at data collected between 1999 and 2020 from the National Health and Nutrition Examination Survey. The team examined 43,321 participants, including 1,583 people with a diagnosed stroke and a matched group without stroke. They focused on the monocyte-to-high-density lipoprotein cholesterol ratio, known as MHR, which compares certain white blood cells to good cholesterol.

The study found that people with elevated MHR had a statistically significant association with a higher risk of stroke. The analysis showed an odds ratio of 1.517, meaning the risk was higher in this group. Subgroup checks confirmed that this link held true across different ages and health backgrounds.

No safety issues were reported because the study looked at existing health records rather than testing a new drug. The main caution is that this study design cannot prove that the ratio causes strokes. Readers should understand that more research is needed to confirm this link over time and to see if it can help doctors treat patients.

What this means for you:

Higher MHR linked to stroke risk in this study, but more research is needed to confirm this connection.

Study Details

Study typeCohort

EvidenceLevel 3

PublishedApr 2026

View Original Abstract ↓

BackgroundStroke is one of the leading causes of death and long-term disability worldwide, and chronic inflammation plays a central role in its pathogenesis. The monocyte-to-high-density lipoprotein cholesterol ratio (MHR) integrates pro-inflammatory activity and anti-atherosclerotic capacity, but its association with stroke risk in the general population remains unclear. This study aims to explore the relationship between MHR and stroke among U.S. adults.MethodsIn this cross-sectional study, we leveraged data from the 1999–2020 National Health and Nutrition Examination Survey (NHANES). Multivariable logistic regression models were employed to examine the relationship between the MHR and stroke risk. Restricted cubic spline (RCS) analysis assessed potential non-linear dose–response relationships, while subgroup analyses evaluated its robustness. Propensity score matching (PSM) was applied to minimize confounding bias through sample refinement.ResultsThe analytical cohort encompassed 43,321 participants, including 1,583 individuals with physician-diagnosed stroke. Following PSM, the non-stroke comparator group was refined to 4,719 subjects. In the fully adjusted multivariable model, elevated MHR demonstrated a statistically significant association with stroke predisposition [Odds ratio (OR) = 1.517; 95% Confidence interval (CI):1.096–2.099]. RCS regression confirmed a linear dose–response gradient between MHR and stroke risk (P-non-linear = 0.9517). Stratified subgroup analyses further validated the robustness of this relationship across demographic and clinical strata (all P for interaction >0.05), indicating consistent effect magnitudes.ConclusionIn this nationally representative cross-sectional study, higher MHR levels were associated with an increased risk of stroke. Although these findings suggest that MHR may be a potential biomarker related to stroke risk, further prospective studies are required to validate its temporal relationship and clinical applicability.

Elevated monocyte-to-HDL ratio associated with stroke predisposition in U.S. adultsHigh monocyte-to-HDL cholesterol ratio linked to higher stroke risk in adults

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Elevated monocyte-to-HDL ratio associated with stroke predisposition in U.S. adultsHigh monocyte-to-HDL cholesterol ratio linked to higher stroke risk in adults

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Study Details

Intravenous tenecteplase improves functional outcomes but increases hemorrhage risk in non-large vessel occlusion acute ischemic stroke

Tenecteplase improves stroke recovery but increases bleeding risk in late treatment window

Clinical research that matters. Delivered to your inbox.

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