LDL/Apo B ratio and Lp (a) Each Predict Coronary Artery Disease in Type2 Diabetes Independent of ASCVD Risk Score: A Case-Cohort Study

Aim: To evaluate the predictive value of the LDL/ApoB ratio for coronary heart disease (CHD) in patients with type2 diabetes (T2D). Methods: In this case-cohort study, (apo)lipoproteins and glycemic indices were measured in 1058 individuals with T2D from February 2002 to March 2019, with a median duration of follow up of 10 years. Results: Of 1058 patients with T2D, coronary heart disease occurred in 242 patients. Increased waist circumference, waist to hip ratio, and hemoglobin A1c, low-density lipoprotein cholesterol (LDL)/Apolipoprotein B (ApoB) ratio, presence of hypertension and metabolic syndrome, and insulin and statin use were more prevalent among patients with CHD (P<0.001). Logistic regression analysis showed that an LDL/ApoB ratio equal or lower than 1.2, as well as a Lp(a) cutoff level more than 25.45 mg/dl could each predict CHD independent of ASCVD risk score [adjusted OR:1.841, CI:1.257 to 2.698, P<0.001 and adjusted OR: 1.433, CI:1.014 to 2.026, P=0.041) respectively ] when adjusted for multiple confounders.The atherogenic index of plasma (AIP) did not predict CHD. Conclusion: This study showed that LDL/ApoB ratio and Lp(a) each, but not the atherogenic index of plasma, may be considered as an indicator of CHD independent of ASCVD risk score in patients with T2D. This finding merits further clarification to optimize preventive strategies for CHD.