title: Predictors of epicardial adipose tissue in patients with type 2 diabetes mellitus.
abstract: BACKGROUND
  Epicardial adipose tissue (EAT), visceral fat depot of the heart, was found to be associated with coronary artery disease in cardiac and non-cardiac patients. Platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) were introduced as potential markers to determine inflammation in various disorders. Recently, atherogenic index of plasma (AIP) was found to be closely associated with atherosclerosis in general population. Waist circumference is commonly used to assess the risk factors in various metabolic disorders. There has been a well known relation between inflammation and peripheral adipose tissue in diabetes mellitus. However, the data regarding EAT and inflammation is scant in this population. Hence, we aimed to determine the relationship between PLR, NLR, AIP, waist circumference and EAT in diabetic patients.
  
  
  METHODS
  This was a cross-sectional study involving 156 patients with type 2 diabetes mellitus (87 females, 69 males; mean age, 53.62 ± 9.33 years) and 50 control subjects (35 females, 15 males; mean age, 51.06 ± 8.74 years). EAT was measured by using a trans-thoracic echocardiogram. Atherogenic index of plasma was calculated as the logarithmically transformed ratio of the serum triglyceride to high density lipoprotein (HDL)cholesterol. NLR and PLR were calculated as the ratio of the neutrophils and platelets to lymphocytes, respectively.
  
  
  RESULTS
  Waist circumference, PLR, NLR, AIP and EAT measurements were significantly higher in diabetic patients when compared to control subjects. When diabetic patients were separated into two groups according to their median value of EAT (Group 1, EAT < 4.53 (n = 78) and group 2, EAT ≥4.53 (n = 78)), group 2 patients had significantly higher Body mass index (BMI), waist circumference, AIP, NLR and PLR levels. In the bivariate correlation analysis, EAT was positively correlated with PLR, NLR, AIP, BMI and waist circumference (r = 0.197, p = 0.014; r = 0.229, p = 0.004; r = 0.161, p = 0.044; r = 0.248, p = 0.002; r = 0.306, p < 0.001, respectively). Waist circumference was found to be independent variables of EAT.
  
  
  CONCLUSIONS
  Simple calculation of PLR and measurement of waist circumference were found to be associated with increased EAT in diabetic patients.
authors.affiliation: Department of Endocrinology, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey.
authors.forename: Emin M
authors.initials: EM
authors.lastname: Akbas
authors.affiliation: Department of Cardiology, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey.
authors.forename: Hikmet
authors.initials: H
authors.lastname: Hamur
authors.affiliation: Department of Internal Medicine, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey.
authors.forename: Levent
authors.initials: L
authors.lastname: Demirtas
authors.affiliation: Department of Cardiology, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey.
authors.forename: Eftal M
authors.initials: EM
authors.lastname: Bakirci
authors.affiliation: Department of Internal Medicine, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey.
authors.forename: Adalet
authors.initials: A
authors.lastname: Ozcicek
authors.affiliation: Department of Internal Medicine, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Ozcicek
authors.affiliation: Department of Anesthesiology and Reanimation, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey.
authors.forename: Ufuk
authors.initials: U
authors.lastname: Kuyrukluyildiz
authors.affiliation: Department of Nephrology, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey.
authors.forename: Kultigin
authors.initials: K
authors.lastname: Turkmen
keywords: Atherogenic index of plasma; Diabetes mellitus; Epicardial adipose tissue; Neutrophil-to-lymphocyte ratio; Platelet-to-lymphocyte ratio; Waist circumference