Background: Coronary artery tortuosity (CorT) is a prevalent angiographic finding commonly associated with aging, hypertension, atherosclerosis and other cardiovascular conditions. It has been suggested that coronary artery tortuosity causes alteration in blood flow and reduction in coronary artery pressure distal to the tortuous segment and can thus lead to ischemia.
Objective: This study aimed to find the relationship between monocytes to high density lipoprotein cholesterol ratio (MHR) and isolated coronary artery tortuosity (CorT) without obstructive coronary artery disease (CAD). Patients and Methods: This study is an observational retrospective case control study that was performed in National Heart Institute and Zagazig University Hospital between January 2018 and January 2020 for patients with stable coronary artery disease that underwent coronary angiography. In this study 60 patients with chronic stable angina were enrolled, 30 patients showed Cor-T without obstructive CAD (cases) on coronary angiography, while the other 30 patients showed normal coronaries (Control).
Results: The most two predictable factors for the detection of Cor-T are MHR and C-reactive protein (CRP).  In Cor-T group there was a significant positive correlation between the number of tortuous vessels and the MHR with P-value <0.001, the more number of tortuous vessels the higher MHR. 
Conclusions: The relationships between the noninvasive laboratory index MHR and coronary artery tortuosity is significant. These findings consider MHR as an accurate, quantitative, non-invasive, highly available and non-expensive parameter for the prediction and detection of Cor-T and may be useful for risk stratification.