title: The Combined Impact of Neutrophil-to-Lymphocyte Ratio and Type 2 Diabetic Mellitus on Significant Coronary Artery Disease and Carotid Artery Atherosclerosis.
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).
  
  
  CONCLUSIONS
  Our results suggest that type 2 diabetic patients with high inflammatory state would be more vulnerable to significant CAD and carotid artery atherosclerosis.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Convergence Medicine & Exercise Science Research Institute, Kosin University School of Medicine, Busan, Korea.
authors.forename: Bong-Joon
authors.initials: BJ
authors.lastname: Kim
authors.affiliation: Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea.
authors.forename: Sang-Hoon
authors.initials: SH
authors.lastname: Cho
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Convergence Medicine & Exercise Science Research Institute, Kosin University School of Medicine, Busan, Korea.
authors.forename: Kyoung-Im
authors.initials: KI
authors.lastname: Cho
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Convergence Medicine & Exercise Science Research Institute, Kosin University School of Medicine, Busan, Korea.
authors.forename: Hyun-Su
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Convergence Medicine & Exercise Science Research Institute, Kosin University School of Medicine, Busan, Korea.
authors.forename: Jung-Ho
authors.initials: JH
authors.lastname: Heo
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Convergence Medicine & Exercise Science Research Institute, Kosin University School of Medicine, Busan, Korea.
authors.forename: Tae-Joon
authors.initials: TJ
authors.lastname: Cha
keywords: Carotid artery atherosclerosis; Coronary artery disease; Diabetes mellitus; Neutrophil-to-lymphocyte ratio