J Cardiovasc Ultrasound.  2016 Jun;24(2):115-122. 10.4250/jcu.2016.24.2.115.

The Combined Impact of Neutrophil-to-Lymphocyte Ratio and Type 2 Diabetic Mellitus on Significant Coronary Artery Disease and Carotid Artery Atherosclerosis

• Kim BJ
• Cho SH
• Cho KI
• Kim HS
• Heo JH
• Cha TJ

• KMID: 2308700
• DOI: http://doi.org/10.4250/jcu.2016.24.2.115

Abstract

BACKGROUND
Neutrophil-to-lymphocyte ratio (NLR) has recently emerged as a new important inflammatory marker for predicting cardiovascular events. This study aimed to evaluate the combined impact of NLR and type 2 diabetes mellitus (T2DM) on significant coronary artery disease (CAD) and carotid artery atherosclerosis.
METHODS
This study includes a total of 828 patients evaluated by coronary angiography and carotid ultrasonography. Significant CAD was defined as at least one vessel with stenosis greater than 50%. We employed logistic regression models to investigate the association of NLR and T2DM with significant CAD. The goodness-of-fit and discriminability of the models were assessed by the loglikelihood ratio test and C-index, respectively. Also, we investigated the clinical relevance of the categorized NLR that classifies patients into three risk groups (low, intermediate, high).
RESULTS
According to logistic regression analysis, both NLR {adjusted odds ratio (OR) 1.31, p < 0.001} and T2DM (adjusted OR 2.46, p = 0.006) were independent risk factors of significant CAD. The addition of NLR and T2DM into a logistic regression model including conventional cardiovascular risk factors significantly improved the goodness-of-fit (p < 0.001) and the discriminability of the model (p = 0.004). Also, T2DM patients assigned into the high risk group (NLR > 2) showed the greater prevalence of significant CAD and carotid artery atherosclerosis compared with patients without T2DM or type 2 diabetic patients assigned into the low risk group (NLR ≤ 1).
CONCLUSION
Our results suggest that type 2 diabetic patients with high inflammatory state would be more vulnerable to significant CAD and carotid artery atherosclerosis.

Keyword

Diabetes mellitus; Neutrophil-to-lymphocyte ratio; Coronary artery disease; Carotid artery atherosclerosis

MeSH Terms

Atherosclerosis*
Carotid Arteries*
Constriction, Pathologic
Coronary Angiography
Coronary Artery Disease*
Coronary Vessels*
Diabetes Mellitus
Diabetes Mellitus, Type 2
Humans
Logistic Models
Odds Ratio
Prevalence
Risk Factors
Ultrasonography

Figure

• 

  Fig. 1 Association of NLR with the severity of CAD; angiographically normal coronary arteries, one-vessel CAD, two-vessel CAD, and three-vessel CAD. NLR was significantly associated with the severity of CAD. CAD: coronary artery disease, NLR: neutrophil-to-lymphocyte ratio.

• 

  Fig. 2 Comparison of receiver operating curves based on four different logistic regression models. Model 1: age + gender + smoking status + HDL + hemoglobin; Model 4: Model 1 + T2DM + NLR. p-value is based on the loglikelihood ratio test; p-value + is based on the Delong's test. HDL: high density lipoprotein, AUC: area under curve, T2DM: type 2 diabetes mellitus, NLR: neutrophil-to-lymphocyte ratio.

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