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Prognostic Value of the Low-Density Lipoprotein Cholesterol/ High-Density Lipoprotein Cholesterol Ratio for Cardiovascular Events in Statin-Treated Type 2 Diabetes With Diabetic Retinopathy Without Prior Cardiovascular Disease
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DOI：10.1253/circj.CJ-25-0841.png)
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Abstract
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Background: We investigated associations between the low-density lipoprotein cholesterol (LDL-C) to high-density lipoprotein cholesterol (HDL-C) ratio (L/H ratio) and cardiovascular events in high-risk type 2 diabetes (T2D) patients with diabetic retinopathy receiving statins. Methods and Results: We conducted a post hoc analysis of the EMPATHY study, a randomized controlled trial comparing intensive vs. standard statin therapy in T2D patients with retinopathy and hypercholesterolemia without cardiovascular disease. Baseline and 12-month (12M) L/H ratios were assessed as single and serial measures. Baseline data were available for 5,006 patients (median L/H ratio 2.016), categorized as having either a high (>_2.0) or low (<2.0) L/H ratio. Over a median 36.8-month follow-up, 184 cardiovascular events occurred. The risk of cardiovascular events was higher in the group with a high than low L/H ratio, even after adjusting for age, sex, and LDL-C (hazard ratio 1.89; 95% confidence interval 1.31-2.73; P<0.001); 12M L/H ratio analysis yielded similar results. In serial categories, both low-high (baseline <2.0; 12M >_2.0) and high-high (baseline >_2.0; 12M >_2.0) groups had higher risk than the low-low group (baseline <2.0; 12M <2.0). No significant interactions were observed by age, sex, LDL-C, HDL-C, or statin intensity. Conclusions: An L/H ratio >_2.0 identifies increased cardiovascular risk in statin-treated T2D patients with diabetic retinopathy and hypercholesterolemia without prior cardiovascular disease. Serial L/H ratio assessment may aid risk stratification in this high-risk population.
Keywords:
Cardiovascular events
Hypercholesterolemia
Low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio
Type 2 diabetes
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