Apolipoproteins, cardiovascular risk and statin response in type 2 diabetes: the Collaborative Atorvastatin Diabetes Study (CARDS)

V. Charlton-Menys, D. J. Betteridge, H. Colhoun, J. Fuller, M. France, G. A. Hitman, S. J. Livingstone, H. A. W. Neil, C. B. Newman, M. Szarek, D. A. DeMicco, P. N. Durrington

    Research output: Contribution to journalArticlepeer-review

    26 Citations (Scopus)


    Controversy surrounds whether the ratio of apolipoprotein B (ApoB) to apolipoprotein A-I (ApoA-I) is the best lipoprotein discriminator of CHD risk in non-diabetic populations, but the issue has never been investigated in type 2 diabetes.

    In 2,627 participants without known vascular disease in the Collaborative Atorvastatin Diabetes Study, ApoB, ApoA-I, LDL-cholesterol (LDLC) and HDL-cholesterol (HDLC) were assayed at baseline.

    There were 108 CHD and 59 stroke endpoints over 3.9 years. The ApoB:A-I ratio at baseline was the lipoprotein variable most closely predicting CHD risk both by comparison of the hazard ratio for a 1 SD change or tertiles of frequency distribution. The areas under the receiver-operator curve for the ApoB:ApoA-I and the LDLC to HDL-HDLC ratios, although not significantly different from each other, were greater (p = 0.0005 and p = 0.0125 respectively) than that of non-HDLC:HDLC. The 27% decrease in the ApoB:ApoA-I ratio on atorvastatin predicted a 32% (95% CI 5.4-51.2%) risk reduction in CHD, close to the 36% decrease observed. Neither the ApoB:ApoA-I nor any other lipoprotein concentration or ratio predicted the stroke outcome.

    Overall, the ApoB:ApoA-I ratio improved on the non-HDLC:HDLC ratio in predicting CHD, but, depending on the assessment chosen, its superiority over LDLC:HDLC may be marginal. The statin-induced decrease in stroke risk may not be lipoprotein mediated.

    Trial registration: ClinicalTrials.gov NCT00327418

    Funding: The study was supported by unrestricted grants from Diabetes UK, the Department of Health and Pfizer to the University of Manchester and to University College, London.

    Original languageEnglish
    Pages (from-to)218-225
    Number of pages8
    Issue number2
    Publication statusPublished - Feb 2009


    • Apolipoproteins
    • Atorvastatin
    • Cardiovascular disease risk
    • Lipoproteins
    • Type 2 diabetes
    • Coronary heart disease
    • Density lipoprotein cholesterol
    • Myocardial infarction
    • Primary prevention
    • A-I
    • Atherosclerosis
    • Metaanalysis
    • Stroke
    • Prediction
    • Guidelines


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