Type 2 Diabetes Mellitus Modifies the Prognostic Value of LDL Particle Size in Statin-treated Patients With Coronary Artery Disease: A Large-scale Cohort Study.

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.