Cardiovascular Mortality in Diabetes: The Role of Lipid ratios and Apolipoprotein (Apo) A-I /Apo B ratio as a Predictive Marker

Abstract

Dyslipidaemia is a common complication among individuals with type 2 diabetes mellitus (T2DM), significantly increasing the risk of cardiovascular disease (CVD). This cross-sectional study investigated the clinical relevance of lipid ratios and apolipoprotein (Apo) B/Apo A-I ratio as predictive markers of cardiovascular risk in 150 participants, categorized into three groups: controls (n=50), T2DM without CVD (n=50), and T2DM with CVD (n=50). Serum lipid profiles and apolipoproteins were measured using enzymatic and immunoturbidimetric methods, and statistical analyses, including ANOVA and receiver operating characteristic (ROC) curve evaluation, were performed.
The results revealed that participants with T2DM and CVD exhibited significantly higher fasting and postprandial glucose levels, total cholesterol, low-density lipoprotein (LDL-C), and triglycerides (TG), along with lower high-density lipoprotein (HDL-C) levels compared to controls and non-CVD diabetics (p<0.001). Lipid ratios, such as total cholesterol: HDL-C and TG: HDL-C, and Apo B/Apo A-I ratio were markedly elevated in the CVD group, indicating pronounced dyslipidaemia. ROC analysis demonstrated that the non-HDL ratio (AUC = 0.608) and Apo A-I/Apo B ratio (AUC = 0.525) provided moderate predictive validity for CVD risk.
The study concludes that combining traditional lipid profiles with apolipoprotein assessments enhances cardiovascular risk stratification in T2DM patients. Comprehensive evaluation of lipid ratios and Apo metrics may improve early identification of high-risk individuals, guiding personalized interventions to mitigate adverse cardiovascular outcomes.