SII, SIRI, NLR, and NHR were independently associated with increased carotid atherosclerosis risk in T2DM patients, while albumin was protective, suggesting inflammation-based composite indices may aid in CAS risk stratification.
Over a median follow-up of 306.5 days, 11.88% of T2DM patients developed incident carotid atherosclerosis.
Higher quartile levels of the Systemic Immune-Inflammation Index (SII) were significantly associated with increased CAS risk in fully adjusted models.
Higher quartile levels of the Systemic Inflammation Response Index (SIRI) were significantly associated with increased CAS risk.
Higher quartile levels of the Neutrophil-to-Lymphocyte Ratio (NLR) were significantly associated with increased CAS risk.
Higher quartile levels of the Neutrophil-to-HDL Ratio (NHR) were significantly associated with increased CAS risk.
Albumin showed an inverse association with incident CAS risk, suggesting a protective effect.
Age- and sex-stratified analyses suggested potential heterogeneity in the associations, though formal interaction tests were not statistically significant.
Of the seventeen composite indices examined, only SII, SIRI, NLR, NHR, and albumin reached statistical significance after multiple comparison correction.
This research examined whether simple blood test calculations could predict the development of carotid atherosclerosis (plaque buildup in the neck arteries, an early sign of heart and stroke risk) in people with type 2 diabetes. The study followed nearly 15,500 diabetic patients over a median of about 10 months, using their hospital records from 2018 to 2024. Researchers calculated 17 different 'composite indices' — ratios and combinations of standard blood test results like white blood cell counts, cholesterol, and protein levels — and tracked which patients later developed carotid atherosclerosis. About 12% of patients developed carotid atherosclerosis during follow-up. Four inflammation-related indices — SII, SIRI, NLR, and NHR — were all linked to a 34–40% higher risk of developing carotid atherosclerosis when comparing patients with the highest versus lower levels. These indices all reflect aspects of immune system activation and inflammation. In contrast, higher albumin levels (a blood protein that tends to be lower when someone is malnourished or chronically ill) were associated with a 26% lower risk. All of these associations held up even after statistical adjustments for multiple comparisons, suggesting they are unlikely to be due to chance alone. This research suggests that routine blood tests already being collected in diabetic patients could be combined into simple ratios to help identify who is at higher risk of developing early arterial disease. Because the study was retrospective — meaning it looked back at existing hospital records rather than following patients in a controlled study — the authors caution that these findings should be considered preliminary. Prospective studies that follow patients forward in time would be needed to confirm whether these indices can reliably guide clinical decision-making for cardiovascular risk management in people with type 2 diabetes.
Li L, Aini W, Jiang S. (2026). Type 2 diabetes mellitus and incident carotid atherosclerosis: a retrospective cohort study on composite indices.. Frontiers in endocrinology. https://doi.org/10.3389/fendo.2026.1904890