NEUTROPHIL TO LYMPHOCYTE RATIO AS A PREDICTIVE MARKER OF ISCHEMIA IN DIABETES MELLITUS TYPE 2 PATIENTS

Abstract

C ardiovascular disease (CVD) is the leading cause of death in type 2 diabetes mellitus (T2DM). T2DM is a significant risk factor in atherosclerotic CVD. DM is considered as a coronary artery disease (CAD) risk equivalent and is associated with an increased risk of cardiovascular morbidity and mortality.180 It has been known that inflammatory processes play a crucial role in CAD. For example, the pro-inflammatory cytokines Interleukin-1 (IL-1) and Interleukin-6 (IL-6) have also been implicated in several mechanisms that contribute to the development of CAD and increased levels of IL-6 are associated with higher cardiovascular mortality. Pro-inflammatory cytokines stimulate the liver to synthesize acute phase proteins, which in turn are associated with a higher risk of cardiovascular events.181 C-reactive protein (CRP) whose concentration in serum is increased in response to inflammatory stimuli is also elevated in acute coronary syndrome compared to stable angina or vasospastic angina. Elevated CRP is associated with increased cardiac morbidity. Increased level of fibrinogen, another acute phase protein, is also reported in patients with asymptomatic atherosclerosis. 182