Retrospective Study
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World J Diabetes. Jun 15, 2025; 16(6): 104120
Published online Jun 15, 2025. doi: 10.4239/wjd.v16.i6.104120
Associations of nontraditional lipoprotein ratios with future cardiovascular events in patients with type 2 diabetes mellitus
Si-Min Deng, Xin-Qun Hu, Xiang-Yu Zhang
Si-Min Deng, Xiang-Yu Zhang, Department of Geriatrics, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
Xin-Qun Hu, Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
Author contributions: Zhang XY designed the research study; Deng SM performed the research and wrote the manuscript; Hu XQ analyzed the data; and all authors have read and approve the final manuscript.
Institutional review board statement: The study was exempt from ethical review and approval, as no additional institutional review board approval was necessary for the secondary analysis.
Informed consent statement: The data for our study are derived from the Action to Control Cardiovascular Risk in Diabetes. All participants completed informed consent forms before participating in the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The original data are available from the NHLBI BioLINCC. Some or all of the data sets generated and/or analyzed in the current study are not publicly available, but may be obtained from the corresponding author upon reasonable request at xiangyuzhang@csu.edu.cn.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiang-Yu Zhang, PhD, Professor, Department of Geriatrics, The Second Xiangya Hospital, Central South University, No. 139 Renmin Middle Road, Changsha 410011, Hunan Province, China. xiangyuzhang@csu.edu.cn
Received: December 11, 2024
Revised: March 30, 2025
Accepted: May 15, 2025
Published online: June 15, 2025
Processing time: 185 Days and 4.5 Hours
Abstract
BACKGROUND

Patients with type 2 diabetes mellitus (T2DM) face a heightened risk of future cardiovascular events. It is therefore important to stratify these patients according to their future cardiovascular event risk to allow early intervention and improve prognosis. Recent proposals have indicated that nontraditional lipoprotein ratios may be superior predictors of cardiovascular events compared to traditional lipid parameters. However, further evidence is required for widespread clinical application.

AIM

To elucidate the associations of nontraditional lipoprotein ratios with future cardiovascular events in patients with T2DM.

METHODS

This study performed post-hoc analysis of data obtained during a clinical trial involving 10182 participants. To ascertain the correlations between nontraditional lipoprotein ratios and future cardiovascular events, including major adverse cardiovascular events (MACEs) and congestive heart failure (CHF). We employed univariable and multivariable-adjusted Cox proportional hazards regression models. Potential dose-response relationships and threshold values were explored by conducting restricted cubic spline analyses and two-piecewise linear regression models. Possible relevant interactions influencing independent relationships were tested using subgroup and interaction analyses.

RESULTS

After adjustment for confounding factors, all nontraditional lipoprotein ratios studied were strongly associated with MACE risk in patients with T2DM. In comparison with patients in the lowest quartile, the hazard ratios (95% confidence intervals) of those in the highest quartile were 1.50 (1.29-1.73), 1.51 (1.30-1.74), 1.50 (1.29-1.73), and 1.30 (1.12-1.50) for total cholesterol/high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol/HDL-C, non-HDL-C/HDL-C, and remnant cholesterol/HDL-C, respectively. Similar findings were noted for CHF. Dose-response relationships between nontraditional lipoprotein ratios and MACE were observed, with threshold values of 7.29, 6.29, and 2.15 for total cholesterol/HDL-C, non-HDL-C/HDL-C, and remnant cholesterol/HDL-C, respectively. However, no notable dose-response relationships were detected between nontraditional lipoprotein ratios and CHF.

CONCLUSION

Elevated nontraditional lipoprotein ratios may independently predict the risk of MACE and CHF in patients with T2DM.

Keywords: Nontraditional lipoprotein ratios; Future cardiovascular events; Prognosis; Major adverse cardiovascular events; Type 2 diabetes mellitus; Congestive heart failure

Core Tip: This research demonstrates that elevated nontraditional lipoprotein ratios may independently predict the risk of major adverse cardiovascular events and congestive heart failure in patients with type 2 diabetes mellitus. Our findings provide evidence supporting the use of nontraditional lipoprotein ratios as reliable bioindicators of cardiovascular event risk in patients with type 2 diabetes mellitus.