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

ABSTRACT 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.