In the article, the authors evaluate the role of the neutrophil-to-lymphocyte ratio (NLR) in abdominal aortic atherosclerosis (AAAt). The backbone of this paper is the knowledge that the development and complications of atherosclerotic plaques are part of an immunological response. They have used the neutrophil-to-lymphocyte ratio (NLR) as an inflammatory marker and have used abdominal aortic ultrasound to evaluate subclinical atherosclerosis through the findings of aortic atheroma or lipid plaque (AAAt). The RNL and acute coronary syndrome results were well established, with the inflammatory state leading to a rise in neutrophils and the acute stress of plaque rupture or obstruction leading to a fall in the lymphocyte count. In a group of 779 patients with ST-elevation myocardial infarction (STEMI), Machado et al. have shown a strong correlation between NLR at 48-72 hours and early and late death. Bozkurt et al. have studied 39 patients with Hemophagocytic syndrome (HPS) and heart failure with preserved ejection fraction. HPS is a state with high lethality, of severe systemic hyper inflammation with increased T lymphocytes and high levels of cytokines. In those patients, NRL was a strong predictor of mortality.

The authors have studied 36.985 individuals through abdominal ultrasound and have found abdominal aortic atherosclerosis in 7% of them. In this group of abdominal aorta asymptomatic atherosclerosis, many individuals had confounding factors for NLR analysis as an atherosclerosis marker, namely age, smoking habit, diabetes, arterial hypertension, and dyslipidemia.

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