Furthermore, an abnormal body mass index, whether too low or excessively high, modulates insulin sensitivity, lipid profiles, and adipokine secretion, potentially amplifying microvascular damage (32) The neutrophil-to-lymphocyte ratio emphasizes the chronic inflammatory milieu that may accelerate these processes through increased oxidative stress, endothelial dysfunction, and vascular permeability. Here, INS is linked to endothelial dysfunction.