biostudies-literatureWu DSpecial Fund Project for Science and Technology Innovation Strategy of Guangdong Province1433https://www.ebi.ac.uk/biostudies/studies/S-EPMC12754891biostudies-literatureUnknown23(1)<h4>Background</h4>A sustained oversupply of monocytes and markedly decreased levels of high-density lipoprotein cholesterol (HDL-C) are notable in high-risk groups with residual cardiovascular risk, despite aggressive low-density lipoprotein cholesterol (LDL-C) lowering. This study aimed to explore whether an imbalance in circulating monocyte and HDL-C levels accounts for the residual risk of incident myocardial infarction (MI) within optimal LDL-C levels.<h4>Methods</h4>A total of 48,522 participants free of cardiovascular diseases from a real-life, prospective cohort (Kailuan study) were included. The monocyte count, HDL-C level and monocyte-to-HDL-C ratio (MHR), calculated as time-averaged cumulative and baseline values, were used as the exposures. Time-to-event survival analyses were Journal of translational medicineImbalances in circulating monocyte and high-density lipoprotein cholesterol exacerbates the residual risk of incident myocardial infarction beyond LDL-C: a real-life, prospective cohort study.PMC12754891202053-75202053-74STKJ2023003Li XDing XWu SWang WChen YWu DBalmer LLan YfalseImbalances in circulating monocyte and high-density lipoprotein cholesterol exacerbates the residual risk of incident myocardial infarction beyond LDL-C: a real-life, prospective cohort study.<h4>Background</h4>A sustained oversupply of monocytes and markedly decreased levels of high-density lipoprotein cholesterol (HDL-C) are notable in high-risk groups with residual cardiovascular risk, despite aggressive low-density lipoprotein cholesterol (LDL-C) lowering. This study aimed to explore whether an imbalance in circulating monocyte and HDL-C levels accounts for the residual risk of incident myocardial infarction (MI) within optimal LDL-C levels.<h4>Methods</h4>A total of 48,522 participants free of cardiovascular diseases from a real-life, prospective cohort (Kailuan study) were included. The monocyte count, HDL-C level and monocyte-to-HDL-C ratio (MHR), calculated as time-averaged cumulative and baseline values, were used as the exposures. Time-to-event survival analyses were 2025-01-01T00:00:00Z2025 Dec2026-07-15T15:35:37.535Z2026-07-06T03:10:43.106ZS-EPMC127548914146971310.1186/s12967-025-07028-7