Related Experiment Video
Updated: Jun 14, 2026
Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
Apolipoprotein B100 predicts cardiovascular and limb events in type 2 diabetes patients with chronic limb-threatening
Federico Biscetti1,2, Maria Margherita Rando3, Maria Anna Nicolazzi3
1Cardiovascular Internal Medicine Unit, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University School of Medicine, Largo Agostino Gemelli 8, 00168, Rome, Italy. f.biscetti@gmail.com.
Insights
Apolipoprotein B100 (ApoB100) levels independently predict cardiovascular and limb events in patients with type 2 diabetes and chronic limb ischemia after revascularization. ApoB100 improves risk prediction beyond standard factors.
Area of Science:
- Cardiovascular Medicine
- Endocrinology
- Vascular Surgery
Background:
- Patients with type 2 diabetes mellitus (T2DM) and chronic limb-threatening ischemia (CLTI) undergoing lower extremity revascularization (LER) have high risks of major adverse cardiovascular events (MACE) and major adverse limb events (MALE).
- Apolipoprotein B100 (ApoB100) reflects atherogenic particle number and may identify residual risk beyond LDL-cholesterol (LDL-C).
Purpose of the Study:
- To investigate if baseline ApoB100 levels independently predict MACE and MALE in T2DM-CLTI patients undergoing LER.
- To assess ApoB100's predictive accuracy and its contribution to risk models.
Main Methods:
- Prospective cohort study of 167 T2DM patients with CLTI undergoing LER.
- 12-month follow-up with baseline ApoB100 measurement.
- Assessed ApoB100's ability to predict MACE, MALE, and composite endpoints using multivariable analyses and ROC analysis.
Main Results:
- Composite events occurred in 49.1% of patients; MACE in 24%; MALE in 35.3%.
- Significantly higher baseline ApoB100 levels in event groups (p < 0.01).
- ApoB100 independently predicted composite events (OR 1.14), MACE (OR 1.10), and MALE (OR 1.05), with excellent predictive accuracy (AUC 0.86). Adding ApoB100 improved model discrimination (p < 0.01).
Conclusions:
- Elevated baseline ApoB100 is an independent predictor of MACE, MALE, and composite events post-LER in T2DM-CLTI patients.
- Integrating ApoB100 improves clinical risk models and can refine individualized therapeutic strategies for residual atherogenic risk.
Background:
Patients with type 2 diabetes mellitus (T2DM) and chronic limb-threatening ischemia (CLTI) undergoing lower extremity revascularization (LER) face high risks of major adverse cardiovascular events (MACE) and major adverse limb events (MALE), despite guideline-directed lipid-lowering therapy. Apolipoprotein B100 (ApoB100), reflecting total atherogenic particle number, may identify residual risk beyond LDL-cholesterol (LDL-C). Therefore, we investigated whether baseline ApoB100 levels independently predict MACE and MALE beyond conventional risk factors in this high-risk population.
Methods:
In this prospective cohort study, 167 T2DM patients with CLTI undergoing LER were followed for 12 months with visits at 1, 3, 6, and 12 months post-procedure. We measured baseline ApoB100 and assessed its ability to predict MACE, MALE, and composite endpoints, adjusting for clinical covariates.
Results:
Composite events occurred in 49.1% of patients, MACE in 24%, and MALE in 35.3%. ApoB100 levels were significantly higher in event groups (composite: 62.1 vs 38.0 mg/dL, p < 0.01; MACE: 66.1 vs 44.4 mg/dL, p < 0.01; MALE: 61.0 vs 42.4 mg/dL, p < 0.01). Multivariable analyses confirmed ApoB100 as an independent predictor (composite OR 1.14 per mg/dL, 95% CI 1.08-1.20, p < 0.01; MACE OR 1.10, p < 0.01; MALE OR 1.05, p < 0.01). ROC analysis demonstrated excellent predictive accuracy for ApoB100 (AUC 0.86, 95% CI 0.80-0.91), with optimal ROC-derived cut-off of 56.6 mg/dL. Adding baseline ApoB100 to conventional risk factors significantly improved model discrimination (AUC gains 0.08-0.15, all p < 0.01), while Kaplan-Meier curves by cut-off effectively stratified early events (log-rank p < 0.001).
Conclusions:
Elevated baseline ApoB100 independently predicted MACE, MALE, and composite events post-LER in T2DM-CLTI patients, substantially improving clinical risk models. Integrating ApoB100 into post-LER management algorithms could refine individualized therapeutic strategies, especially in patients with residual atherogenic risk despite optimal LDL-C control.
Related Concept Videos
01:30Peripheral Artery Disease I: Introduction
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
01:24Type II Diabetes II: Pathophysiology
01:26Type I Diabetes II: Pathophysiology
01:25Type II Diabetes Mellitus III: Clinical Manifestations and Diagnosis
01:30Coronary Artery Disease I: Introduction