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Lower LDL-c/ApoB ratio is associated with adverse cardiovascular outcomes and advanced peripheral artery disease

Sanjiv Keller1, Xhyljeta Luta1, Lucia Mazzolai1

  • 1Angiology Department, Lausanne University Hospital (CHUV), Lausanne University (UNIL), Lausanne, Switzerland.

VASA. Zeitschrift Fur Gefasskrankheiten
|July 6, 2026
PubMed

Insights

Lower LDL-c/ApoB ratios are linked to increased cardiovascular risk in peripheral artery disease (PAD) patients. This highlights the importance of assessing the full lipid profile beyond LDL-c alone for better cardiovascular risk prediction.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Lipidology

Background:

  • Low-density-lipoprotein-cholesterol (LDL-c) alone may underestimate cardiovascular (CV) risk.
  • Apolipoprotein B (ApoB) and the LDL-c/ApoB ratio show promise as more accurate CV risk markers.
  • Prognostic value of these lipid parameters in peripheral artery disease (PAD) outcomes requires further investigation.

Purpose of the Study:

  • To investigate the correlation between lipid parameters and cardiovascular outcomes in PAD patients.
  • To assess the association of LDL-c/ApoB ratio tertiles with major adverse cardiac and limb events (MALE) and major adverse cardiac events (MACE).

Main Methods:

  • Analysis of consecutive PAD patients from the Peripheral ARTEry Disease (PARTED) registry.
  • Collection of demographic, clinical, and lipid parameters (LDL-c, Lp(a), ApoB).
  • Stratification of patients into tertiles based on LDL-c/ApoB ratio and evaluation of prior MACE/MALE using multivariate logistic regression.

Main Results:

  • A total of 339 PAD patients (mean age 71, 68% male) were included.
  • Lower LDL-c/ApoB ratio tertiles (low and intermediate) were significantly associated with prior MACE (OR 2.09 and 2.06, respectively).
  • No significant association was found between prior MACE and LDL-c or ApoB tertiles alone.

Conclusions:

  • Lower LDL-c/ApoB ratios (LAR) are independently associated with a history of MACE in PAD patients.
  • Comprehensive lipid profiling, including the LDL-c/ApoB ratio, is crucial for accurate CV risk assessment in PAD.
  • Further research is needed to clarify if LAR predicts treatment intensification or retains prognostic value for historical events.

Keywords:
MACEMALEPADPARTEDlipoprotein

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