Key result
In statin-treated patients with coronary artery disease and type 2 diabetes, a higher LDL-C/ApoB ratio (≥1.2) was associated with a decreased risk of MACE (HR 0.81; 95% CI 0.69-0.96).
Why the study?
Does the LDL-C/ApoB ratio predict major adverse cardiac events in statin-treated patients with coronary artery disease, and is this association modified by type 2 diabetes mellitus?
Cohort (n=21,382)
Does the LDL-C/ApoB ratio predict major adverse cardiac events in statin-treated patients with coronary artery disease, and is this association modified by type 2 diabetes mellitus?
Answers are grounded in this paper and cite their sources.
In statin-treated patients with CAD, a higher LDL-C/ApoB ratio (indicating larger LDL particle size) is associated with a lower risk of MACE specifically in those with type 2 diabetes, suggesting it may be a better indicator of residual risk than LDL-C in this population.
LDL‐cholesterol (LDLC) to apolipoprotein B (ApoB) ratio is an accessible and reliable proxy for the LDL‐particle size. The aim of the present study was to investigate whether type 2 diabetes mellitus (T2DM) modulates the prognostic value of LDL‐C/ApoB ratio in statin‐treated patients with coronary artery disease (CAD). The study included 21,382 patients with CAD who had received statin therapy at baseline with a median follow‐up of 3.1 years. The primary endpoint was major adverse cardiac events (MACE), including all‐cause mortality, non‐fatal myocardial infarction (MI), and ischemia‐driven revascularization. Higher LDL‐C/ApoB level (≥1.2) was associated with a decreased risk of MACE in the T2DM group (adjusted HR: 0.81, 95% CI: 0.69–0.96). A stepwise increase of 0.1 unit in LDL‐C/ApoB ratio was associated with a 5% decrease for MACE only in the T2DM group. Among participants without T2DM, there was no clear association between LDL‐C/ApoB and MACE ( p for interaction < 0.05). No significant association was identified between MACE risk and LDL‐C or ApoB in the T2DM group. Our data demonstrated that in CAD patients who had received statin therapy, LDL‐C/ApoB ratio was related to adverse prognosis only in those with T2DM. Among patients with CAD and T2DM who are receiving statin treatment, LDL‐C/ApoB may be a better indicator of residual cholesterol risk than LDL‐C.
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Bian et al. (2026) conducted a cohort in Coronary artery disease (CAD) (n=21,382). Higher LDL-C/ApoB level (≥1.2) vs. Lower LDL-C/ApoB level was evaluated on Major adverse cardiac events (MACE), including all-cause mortality, non-fatal myocardial infarction (MI), and ischemia-driven revascularization (HR 0.81, 95% CI 0.69-0.96). In statin-treated patients with coronary artery disease and type 2 diabetes, a higher LDL-C/ApoB ratio (≥1.2) was associated with a decreased risk of MACE (HR 0.81; 95% CI 0.69-0.96).
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