Association of Lipid Ratios With Cardiovascular Outcomes in Type 2 Diabetes: A Population Cohort Study

To identify low- and high-risk intervals for major adverse cardiovascular events (MACE) and all-cause mortality according to lipid ratios in adults with Type 2 diabetes mellitus (T2DM), stratified by sex.

We used primary care electronic health records from the Spanish National Health Service including 303 199 adults with T2DM followed for a mean of 5.7 years (1.7 million person-years). Lipid indices were triglycerides/HDL cholesterol (TG/HDL-C), total cholesterol/HDL cholesterol (TC/HDL-C), non-HDL cholesterol/HDL cholesterol, LDL cholesterol/HDL cholesterol and the triglyceride-glucose (TyG) index. The outcome was a composite of all-cause mortality or hospitalisation for cerebrovascular or ischemic heart disease. Sex-specific Weibull models adjusted for clinical covariates were applied.

U-shaped associations were observed between lipid ratios and outcomes. Increased risk was associated with higher ratios in both sexes, with slightly lower risk thresholds in women, while very low values were also linked to excess risk.

Extremes of lipid ratios were associated with higher cardiovascular risk, suggesting that moderate ranges may be protective. These easily obtainable markers may improve risk stratification and personalised prevention in T2DM care.