A multidimensional approach to assess cardiovascular disease risk combining biochemical, hematological, lipid ratios, atherosclerotic cardiovascular disease, and WHO/ISH 10-year risk estimators: a cross-sectional study.

Cardiovascular disease (CVD), a leading global health concern and the primary cause of death worldwide, is often associated with atherosclerosis and cardiac events. OBJECTIVE: This study evaluated biochemical and hematological parameters as predictors of CVD risk using atherosclerotic CVD and World Health Organization/International Society of Hypertension risk scores (WHO/ISH). METHODOLOGY: 102 volunteer participants representing 69 males (67.6%) and 33 females (32.4%) from the Health and Administrative Staff of University Hospital-General Sir John Kotelawala Defence University, Sri Lanka, were selected. Patient demographics, biometrics, clinical parameters, and behavioral risk factors were collected. Laboratory parameters: complete blood count, lipid profile, aspartate and alanine aminotransferases were performed. The 10-year CVD risk was estimated using the "ASCVD-Risk Estimator-Plus" and WHO/ISH risk score charts; South Asia and Southeast Asia. The data were analyzed using IBM-SPSS-version26. RESULTS: The study population showed strong to moderate-strong correlations within the hematological, biochemical, and risk estimators, but not between these parameters. Platelets-to-Lymphocytes Ratio (PLR) had a strong, significant positive correlation with the Neutrophils-to-Lymphocyte Ratio (NLR) and a moderately strong, significant positive correlation with Platelets and NLR (r=0.446; P<0.001), indicating the inflammatory response, atherosclerosis with increased CVD risk. In the regression analysis, the HDL-LDL ratio was found to independently predict the TC-HDL ratio and successfully combined the WHO/ISH risk estimators with the collected biochemical, hematological, clinical, biometric, and behavioral risk factors by introducing highly predictive, well-fit equations. The ROC analysis indicated that once the HDL-LDL-ratio reduces below 0.39, ASCVD-10-year-risk (ASCVD_10) and ASCVD-lifetime-risk (ASCVD_LT) increase to 4.95 and 37.5, respectively. CONCLUSION: A strong positive correlation was found between NLR, PLR, and CVD risk, with a moderate correlation between PLT and NLR. ASCVD_10 showed a reliable link with ASCVD_OP and ASCVD_LT, marking the first comparison of all three risk types. Predictive equations were developed by integrating WHO/ISH scores and other parameters. The TC-HDL ratio significantly correlated with the HDL-LDL ratio, enabling a cut-off value to predict ASCVD_10 risk and associated hematological and biochemical markers.