Relationship of HbA1c, Triglyceride-Glucose Index and Neutrophil-to-Lymphocyte Ratio with Coronary Artery Disease Severity in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study

Iqra Iqbal; Shanza Akram; Hammad Khalid Lodhi; Ahmed Hussain; Maryam Shahzad; Hamayal Amir

doi:10.54112/bcsrj.v7i6.2346

Authors

Iqra Iqbal CMH, Lahore, Pakistan
Shanza Akram NCHD, Ireland
Hammad Khalid Lodhi CMH, Lahore, Pakistan
Ahmed Hussain CMH, Lahore, Pakistan
Maryam Shahzad CMH, Lahore, Pakistan
Hamayal Amir CMH, Lahore, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v7i6.2346

Keywords:

Coronary Artery Disease; Diabetes Mellitus, Type 2; Glycated Hemoglobin A; Insulin Resistance; Neutrophil-Lymphocyte Ratio

Abstract

Coronary artery disease is a major cause of morbidity and mortality among patients with type 2 diabetes mellitus. Simple hematological and biochemical biomarkers may help identify patients with greater coronary disease burden. Objective: To assess the relationship of HbA1c, triglyceride-glucose index, and neutrophil-to-lymphocyte ratio with coronary artery disease severity in patients with type 2 diabetes mellitus. Methods: This cross-sectional study was conducted at CMH Lahore over six months, from May 2024 to October 2024. A total of 180 patients with type 2 diabetes mellitus undergoing coronary angiography for suspected or confirmed coronary artery disease were included. Fasting blood samples were analyzed for HbA1c, fasting plasma glucose, triglycerides, and complete blood count. The triglyceride-glucose index and neutrophil-to-lymphocyte ratio were calculated using standard formulas. Coronary artery disease severity was assessed using the Gensini score. Associations of HbA1c, triglyceride-glucose index, and neutrophil-to-lymphocyte ratio with coronary artery disease severity were evaluated using correlation and multivariable regression analyses. A p-value <0.05 was considered statistically significant. Results: Among 180 participants, severe coronary artery disease was observed in 78 patients (43.3%). Patients with severe coronary artery disease had significantly higher HbA1c, triglyceride-glucose index, and neutrophil-to-lymphocyte ratio compared with those having mild or moderate disease (p<0.001). All three biomarkers showed significant positive correlations with Gensini score. The stronges wed stronger independent predictive value and may serve as simple, readily available biomarkers for cardiovascular risk stratification in diabetic patients undergoing coronary angiography.

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References

1. American Diabetes Association Professional Practice Committee. Standards of care in diabetes—2024. Diabetes Care. 2024;47(Suppl 1):S1-S321.

2. Low Wang CC, Hess CN, Hiatt WR, Goldfine AB. Clinical update: cardiovascular disease in diabetes mellitus: atherosclerotic cardiovascular disease and heart failure in type 2 diabetes mellitus—mechanisms, management, and clinical considerations. Circulation. 2016;133(24):2459-2502. DOI: https://doi.org/10.1161/CIRCULATIONAHA.116.022194

3. Cosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020;41(2):255-323. DOI: https://doi.org/10.1093/eurheartj/ehz486

4. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412-419. DOI: https://doi.org/10.1007/BF00280883

5. Simental-Mendía LE, Rodríguez-Morán M, Guerrero-Romero F. The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metab Syndr Relat Disord. 2008;6(4):299-304. DOI: https://doi.org/10.1089/met.2008.0034

6. Guerrero-Romero F, Simental-Mendía LE, González-Ortiz M, Martínez-Abundis E, Ramos-Zavala MG, Hernández-González SO, et al. The product of triglycerides and glucose, a simple measure of insulin sensitivity: comparison with the euglycemic-hyperinsulinemic clamp. J Clin Endocrinol Metab. 2010;95(7):3347-3351. DOI: https://doi.org/10.1210/jc.2010-0288

7. Sánchez-Íñigo L, Navarro-González D, Fernández-Montero A, Pastrana-Delgado J, Martínez JA. The TyG index may predict the development of cardiovascular events. Eur J Clin Invest. 2016;46(2):189-197. DOI: https://doi.org/10.1111/eci.12583

8. Won KB, Kim YS, Lee BK, Heo R, Han D, Lee JH, et al. The relationship of insulin resistance estimated by triglyceride glucose index and coronary plaque characteristics. Medicine (Baltimore). 2018;97(21):e10726. DOI: https://doi.org/10.1097/MD.0000000000010726

9. Imtiaz F, Shafique K, Mirza SS, Ayoob Z, Vart P, Rao S. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med. 2012;5:2. DOI: https://doi.org/10.1186/1755-7682-5-2

10. Bhat T, Teli S, Rijal J, Bhat H, Raza M, Khoueiry G, et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Rev Cardiovasc Ther. 2013;11(1):55-59. DOI: https://doi.org/10.1586/erc.12.159

11. Azab B, Zaher M, Weiserbs KF, Torbey E, Lacossiere K, Gaddam S, et al. Usefulness of neutrophil to lymphocyte ratio in predicting short- and long-term mortality after non-ST-elevation myocardial infarction. Am J Cardiol. 2010;106(4):470-476. DOI: https://doi.org/10.1016/j.amjcard.2010.03.062

12. Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol. 1983;51(3):606. DOI: https://doi.org/10.1016/S0002-9149(83)80105-2

13. Libby P. Inflammation in atherosclerosis. Nature. 2002;420(6917):868-874. DOI: https://doi.org/10.1038/nature01323

14. Ross R. Atherosclerosis—an inflammatory disease. N Engl J Med. 1999;340(2):115-126. DOI: https://doi.org/10.1056/NEJM199901143400207

15. Emerging Risk Factors Collaboration, Di Angelantonio E, Gao P, Pennells L, Kaptoge S, Caslake M, et al. Glycated hemoglobin measurement and prediction of cardiovascular disease. JAMA. 2014;311(12):1225-1233. DOI: https://doi.org/10.1001/jama.2014.1873

16. Fox CS, Golden SH, Anderson C, Bray GA, Burke LE, de Boer IH, et al. Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation. 2015;132(8):691-718. DOI: https://doi.org/10.1161/CIR.0000000000000230

17. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139(25):e1082-e1143. DOI: https://doi.org/10.1161/CIR.0000000000000698

18. Yusuf S, Hawken S, Ôunpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries: the INTERHEART study. Lancet. 2004;364(9438):937-952. DOI: https://doi.org/10.1016/S0140-6736(04)17018-9