Aim To explore the diagnostic value of peripheral blood monocyte to high density lipoprotein cholesterol ratio (MHR) in lower extremity arterial stenosis. Methods 311 consecutive cases treated in the Eighth Affiliated Hospital of Sun Yat-sen University from August 2018 to August 2020 were selected. According to the degree of lower extremity arterial stenosis, the patients were divided into four groups:(1)control group (n＝65):lower extremity artery was normal; (2)mild lesion group (n＝77):30%≤lower extremity arterial stenosis＜50%; (3)moderate lesion group (n＝60):50%≤lower extremity arterial stenosis ≤ 75%; (4)severe lesion group (n＝109):lower extremity arterial stenosis＞75% or occlusion. MHR was calculated. The clinical data and laboratory results of the four groups were collected and compared. The influencing factors of lower extremity arterial stenosis and the diagnostic value of MHR in lower extremity arterial stenosis were analyzed. Results The differences in age, MHR, high-sensitivity C-reactive protein, hemoglobin, high-density lipoprotein cholesterol, serum creatinine (SCr), blood uric acid, blood homocysteine, history of hypertension, and history of diabetes were statistically significant among the four groups (P＜0.05). Multivariate Logistic regression analysis showed that advanced age, high MHR, high SCr and history of diabetes were risk factors for patients with lower extremity arterial stenosis (P＜0.05). Based on the predicted probability obtained from the multivariate Logistic regression model, the ROC curve was drawn, and the area under the curve was 0.953; When the predicted probability is 0.86, the sensitivity and specificity for the diagnosis of lower extremity arterial stenosis were 85.8% and 92.3%.Conclusions High MHR is a risk factor for lower extremity arterial stenosis. The multivariate Logistic regression model established in this article has a high diagnostic value for lower extremity arterial stenosis.