Apolipoprotein B and non-high-density lipoprotein cholesterol reveal a high atherogenicity in individuals with type 2 diabetes and controlled low-density lipoprotein-cholesterol

Abstract Purpose: Lipid-lowering therapy is guided by Low-density-lipoprotein cholesterol (LDL-c), although the CVD risk could be better reflected by other lipid parameters. This study aimed the evaluation of a comprehensive lipid profile in patients with type 2 diabetes mellitus (T2DM) and comparation of those achieving and not achieving LDL-c control in respect to other non-conventional lipid parameters. Methods: We characterized a comprehensive lipid profile in 96 T2DM patients. ESC/EAS 2016 and 2019 Guidelines for the Management of Dyslipidemias were used to define LDL-c targets. Atherogenic lipoprotein profile was compared in patients with LDL-c within and above the target. Results: Only 28.1% and 16.7% of patients had mean LDL-c levels within the 2016 and 2019 guidelines, respectively. In patients with LDL-c within target by the 2016 guidelines, 22%, 25% and 44% presented levels above the recommended range for non-HDL-c, ApoB and oxidized LDL-c, respectively, whereas accordingly to the 2019 guidelines, 50%, 39% and 44% had elevated levels of -HDL-c, ApoB and oxidized LDL-c, respectively. There was a significant strong association of LDL-c and non-HDL-c (r=0.850), ApoB (r=0.656) and oxidized LDL-c (r=0.508). Similarly, non-HDL-c was significantly strongly correlated with ApoB (r=0.808) and oxidized LDL-c (r=0.588). Conclusions: These findings emphasize the limitations of a sole LDL-c measurement for CV risk assessment. Targeting only LDL-c could result in missed opportunities for CV risk reduction in T2DM individuals. Our data suggest that non-HDL-c, ApoB and oxidized LDL-c could be considered as part of these patients’ evaluation allowing a more accurate estimation of CV risk and treatment among these high-risk patients.