The LDL-C/Apo B ratio predicts mortality in heart failure patients both with and without type 2 diabetes

Abstract Introduction A low LDL-C/Apo B ratio reflects small LDL particle size which like type 2 diabetes (T2DM) is associated with insulin resistance and reflects an unfavorable lipid profile. The LDL-C/Apo B ratio has been shown to be predictive of cardiovascular events in patients with atherosclerotic disease and of cardiovascular and overall mortality in the general population. Purpose The purpose of the study was to investigate whether the LDL-C/ApoB ratio predicts mortality in patients with heart failure independently of the presence of T2DM. Methods We enrolled a cohort of 349 patients with clinically evident heart failure, including patients with HFpEF, HFmrEF and HFrEF. T2DM was diagnosed in 140 (40.1%) of these patients according to current ADA guidelines. Prospectively, mortality was recorded over a mean follow-up period of 3.0 ± 2.5 years. Results At baseline, the LDL-C/Apo B ratio was significantly lower in patients with T2DM than in subjects who did not have T2DM (0.93 ± 0.21 vs. 1.04 ± 0.19, p0.001). During follow-up, 158 patients died; the mortality rate was higher in patients with than in those without T2DM (55.0 % vs. 40.2%; p0.001). The LDL-C/ApoB ratio predicted mortality in univariate analysis (HR 0.73 0.62-0.86; p0.001) and after adjustment for age, gender, BMI, hypertension, smoking, LDL-C, HDL-C, triglycerides, NT-proBNP and T2DM (HR 0.55 0.42-0.75; p0.001). In this multivariate adjusted Cox regression model, the LDL-C/Apo B ratio significantly predicted mortality in patients with T2DM (HR 0.51 0.33-0.79; p=0.003) as well as in those without T2DM (HR 0.61 0.39-0.93; p=0.022) Conclusion Our findings indicate that the LDL-C/Apo B ratio is a robust predictor of mortality in heart failure patients, irrespective of T2DM state.