Ability of traditional lipid ratios and apolipoprotein ratios to predict cardiovascular risk in people with type 2 diabetes
Open accessAbstract
Aims/hypothesis The apolipoprotein B (ApoB):apolipoprotein A (ApoA)-I ratio may be a better indicator of cardiovascular disease (CVD) risk in people with type 2 diabetes than traditional lipid risk markers (LDL-cholesterol, HDL-cholesterol and triacylglycerol), but whether the ApoB:ApoA-I ratio should be used to indicate lipid-lowering therapy is still debated.Methods The Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study randomised 9,795 patients with type 2 diabetes to fenofibrate (200 mg daily) or placebo and followed them up for a median of 5 years. We compared ApoB, ApoA-I, ApoAII and the ApoB:ApoA-I ratio with traditional lipid variables as predictors of CVD risk. We estimated the HR of the effect of 1 SD difference in baseline concentrations of lipids, apolipoproteins and respective ratios on the risk of CVD events and also used receiver operating characteristic curve analysis.Results In the placebo group, the variables best predicting CVD events were non-HDL-cholesterol:HDL-cholesterol, total cholesterol:HDL-cholesterol (HR 1.21, p < 0.001 for both), ApoB:ApoA-I (HR 1.20, p < 0.001), LDL-cholesterol:HDL-cholesterol (HR 1.17, p < 0.001), HDL-cholesterol (HR 0.84, p < 0.001) and ApoA-I (HR 0.85, p < 0.001). In the fenofibrate group, the first four predictors were very similar (but ApoB:ApoA-I was fourth), followed by non-HDL-cholesterol and ApoB. Lipid ratios and ApoB:ApoA-I performed better than any single lipid or apolipoprotein in predicting CVD risk.Conclusions/interpretation In patients with type 2 diabetes in the FIELD study, traditional lipid ratios were as strong as the ApoB:ApoA-I ratio in predicting CVD risk. The data provide little evidence for replacement of traditional lipids and their ratios with measures of ApoB, ApoA-I and their ratio.
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In people with diabetes in the FIELD study, apolipoprotein B gave no benefit beyond traditional lipid markers.
“apo B provided no benefit beyond traditional lipid markers in people with diabetes in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study.47”
From ESC/EAS Guidelines for the management of dyslipidaemias (2011) · cites this paper as [47]
In type 2 diabetes patients in the FIELD study, traditional lipid ratios (non-HDL-C/HDL-C and TC/HDL-C) predicted CVD risk as strongly as the apo B/apo A1 ratio and captured the impact of both atherogenic and antiatherogenic particles.
“Recent data from patients with type 2 diabetes in the FIELD study revealed that traditional lipid ratios (non-HDL-C/HDL-C, TC/ HDL-C) were as strong predictors for CVD risk as the apo B/apo A1 ratio, and captured the impact of both atherogenic and antiatherogenic particles on CVD risk.47”
From ESC/EAS Guidelines for the management of dyslipidaemias (2011) · cites this paper as [47]
In people with diabetes in the FIELD study, apolipoprotein B provided no benefit beyond traditional lipid markers.
“Likewise, apoB provided no benefit beyond traditional lipid markers in people with diabetes in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. 102”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [102]
In the FIELD study, apoB provided no benefit beyond traditional lipid markers in people with diabetes.
“Likewise, apoB provided no benefit beyond traditional lipid markers in people with diabetes in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study.102”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [102]
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Self-citationESC/EAS Guidelines for the management of dyslipidaemias
Catapano, A. L., Reiner, Ž., De Backer, G., Graham, I., Taskinen, M.-R., Wiklund, O., Agewall, S., Alegria, E., Chapman, M. J., Durrington, P., et al. (2011) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2011.06.028 · Cited by 706 · see citing works
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Catapano, A. L., Reiner, Ž., De Backer, G., Graham, I., Taskinen, M.-R., Wiklund, O., Agewall, S., Alegria, E., Chapman, M. J., Durrington, P., et al. (2011) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2011.06.012 · Cited by 192 · see citing works
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- Authors
- on behalf of the FIELD study investigators, Taskinen, M.-R., Barter, P. J., Ehnholm, C., Sullivan, D. R., Mann, K., Simes, J., Best, J. D., Hamwood, S., & Keech, A. C.
- Affiliations
- Helsinki University Hospital (FI)
- The University of Sydney (AU)
- Royal Prince Alfred Hospital (AU)
- The University of Melbourne (AU)
- Corresponding author
- Taskinen, M.-R.
- Venue
- Diabetologia
- Published
- 2010-06-06
- Volume
- 53
- Issue
- 9
- Pages
- 1846-1855
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W2111587776
- Cited by
- 94
- References
- 50
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 4 · 2023: 5 · 2022: 4 · 2021: 7 · 2020: 7 · 2019: 3 · 2018: 2 · 2017: 4 · 2016: 6 · 2015: 4 · 2014: 7 · 2013: 10 · 2012: 8
- FWCI
- 10.72
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Bristol-Myers Squibb
- Pfizer
- AstraZeneca
- Sanofi
- Kowa Company
- Medical Research Council
- National Health and Medical Research Council
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
- Keywords
- apolipoprotein B, apolipoprotein A-I, apolipoprotein B/apolipoprotein A-I ratio, lipid ratios, cardiovascular risk prediction, type 2 diabetes, fenofibrate, fieldwork, non-HDL cholesterol, HDL cholesterol, LDL cholesterol, apolipoprotein A-II, lipid-lowering therapy, cardiovascular events, prognostic value
- MeSH terms
- Aged, Hypolipidemic Agents, Apolipoproteins, Apolipoproteins B, Cardiovascular Diseases, Cholesterol, Diabetes Mellitus, Type 2, Female, Humans, Lipids, Cholesterol, HDL, Male, Middle Aged, Fenofibrate, Risk Factors, Triglycerides, Apolipoprotein A-I, Apolipoprotein A-II
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