Abstract Background: The monocyte to high-density lipoprotein cholesterol ratio has emerged as a novel inflammatory marker in the fields of cardiovascular disease. To explore the relationship between monocyte to high-density lipoprotein cholesterol ratio(MHR) and the occurrence of coronary microvascular disease(CMVD). Methods: 289 patients with angina symptoms and no obvious obstructive coronary arteries were enrolled in our hospital from September 2019 to June 2021. CMVD was diagnosed by coronary flow reserve (CFR). According to the CFR, 158 patients in CMVD group(CFR≤2), 131 patients in non-CMVD group(CFR>2). The differences in baseline clinical characteristics and MHR between the two groups were compared. And the significative influencing factors of CMVD were analyzed by multivariate Logistic regression. The operating characteristic curve(ROC) was drawn to evaluate the predictive of influencing factors. Results: Compared with NO-CMVD group, triglyceride, monocyte count , MHR, blood platelet was significantly increased in CMVD group(p<0.05), but high-density lipoprotein cholesterol was decreased in CMVD group(p<0.05). From multivariate logistic regression analysis, MHR, monocyte count and high-density lipoprotein cholesterol were all independent factors for patient.(p<0.01). ROC curve showed that the area under ROC curve of MHR in predicting CMVD was 0.738[95%CI为（0.679，0.794）. MHR can be better in predicting the occurrence of CMVD. Conclusion: MHR was shown to be an independent risk factor associated with the occurrence of CMVD. And it also can well predict the occurrence of CMVD.