Association of neutrophil-to-lymphocyte ratio with Systematic Coronary Risk Evaluation (SCORE) in cardiovascular risk stratification

Introduction

Cardiovascular disease remains the leading cause of mortality worldwide, making accurate risk stratification essential for effective prevention. The Systematic Coronary Risk Evaluation (SCORE), estimates the 10-year risk of fatal cardiovascular events based on conventional risk factors. However, it does not account for the inflammatory component of atherosclerosis. The neutrophil-to-lymphocyte ratio (NLR) is an inexpensive and easily accessible marker of systemic inflammation.

This study aims to evaluate the correlation between NLR and SCORE in patients undergoing cardiovascular risk assessment.

Material and method

This was a prospective study conducted over a two-year period between 2024 and 2026 , including 700 patients aged 45 to 69 years from the northern region of Morocco. For each participant, the Systematic Coronary Risk Evaluation (SCORE), recommended by the European Society of Cardiology, and the neutrophil-to-lymphocyte ratio (NLR) were calculated. Clinical and biological data were systematically collected. All data were entered, coded, and analyzed using IBM SPSS Statistics to assess the correlation between NLR and cardiovascular risk estimated by SCORE.

Results

A total of 700 patients were included in this prospective study. The mean age was 55 years, with a slight male predominance (56%). Hypertension was present in 48% of patients, diabetes in 32%, and 27% were active smokers.

According to SCORE classification, 22% of patients were categorized as low risk, 34% as moderate risk, 28% as high risk, and 16% as very high risk. The mean neutrophil-to-lymphocyte ratio (NLR) in the overall population was 3.02 ± 1.28.

A progressive increase in NLR values was observed across increasing SCORE categories: 2.14 ± 0.76 in the low-risk group, 2.71 ± 0.94 in the moderate-risk group, 3.48 ± 1.12 in the high-risk group, and 4.26 ± 1.63 in the very high-risk group.

Correlation analysis demonstrated a significant positive correlation between NLR and SCORE. (r = 0.41, p < 0.001).

Conclusion

The neutrophil-to-lymphocyte ratio (NLR) is moderately associated with the SCORE and represents a simple and accessible inflammatory marker that could complement cardiovascular risk assessment, particularly in patients at intermediate risk. Its use could improve risk stratification and guide preventive decisions when traditional risk factors alone are insufficient. These findings highlight the potential of NLR as a complementary tool in the overall assessment of cardiovascular risk.