Background The prognosis of acute myeloid leukemia subtype M2 (AML-M2) varies among patients due to individual differences. The ratio of low-density lipoprotein cholesterol (LDL-C) to high-density lipoprotein cholesterol (HDL-C) and body mass index (BMI) have been proven to be associated with the occurrence and development of various cancers. However, there is currently a lack of research on LDL-C/HDL-C and BMI in AML-M2. Objective To explore the influence of LDL-C/HDL-C and BMI on the treatment prognosis of patients with AML-M2. Methods Adult AML-M2 patients treated in 980 Hospital of Joint Logistic Support Force from January 2020 to December 2022 were prospectively selected as study subjects. According to the levels of LDL-C/HDL-C and BMI, the subjects were divided into low LDL-C/HDL-C group, high LDL-C/HDL-C group, low BMI group, and high BMI group. Clinical data about patients in each group were compared. Kaplan-Meier survival analysis and COX regression were used to analyze the impact of LDL-C/HDL-C and BMI on the prognosis of adult patients with AML-M2. Results A total of 118 patients were included in the study, including 55 males and 63 females. A total of 113 patients were successfully followed up for 2 years. Among them, OS death was positive in 76 cases, while negative in 37 cases. According to the ratio of LDL-C/HDL-C (total sample level was 2.38±0.44), and the mean value of 2.37 was taken as the cut-off threshold of the groups, the subjects were divided into low LDL-C/HDL-C group (LDL-C/HDL-C < 2.37) and high LDL-C/HDL-C group (LDL-C/HDL-C ≥ 2.37). Subjects with BMI < 23kg/m2 were divided into low BMI group and those with BMI≥23 kg/m2 were divided into high BMI group according to their BMI level (total sample level was 22.63±1.80 kg/m2 ). The OS rate, RFS rate, median OS time, and median RFS time in the low LDL-C/HDL-C group were all higher than those in the high LDL-C/HDL-C group (40.04% vs 20.33%, 38.57% vs 20.33%, 17.3 months vs 15.1 months, 15.6 months vs 12.4 months, Logrank test P < 0.05); The low BMI group had higher OS rate, RFS rate, median OS time and median RFS time than the high BMI group (40.00% vs 19.39%, 38.75% vs 19.39%, 17.8 months vs 14.6 months, 15.4 months vs 12.3 months, Logrank test P < 0.05). COX regression analysis showed that BMI≥23kg/m2 (HR=1.591, 95%CI: 1.215-3.036, P＜0.001), LDL-C/HDL-C≥2.37(HR=1.703, 95%CI: 1.452 - 3.261, P＜0.001), age ≥50 years (HR=2.228, 95%CI: 1.921 - 2.891, P＜0.001), extramedullary invasion (HR=1.926, 95%CI: 1.892 - 2.614, P＜0.001), complex karyotype (HR= 1.774, 95%CI: 1.314 - 2.364, P0.000), non-hematopoietic stem cell transplantation (HR=1.943, 95%CI: 1888 - 3.063, P＜0.001) were independent risk factors influencing the OS time of patients. BMI≥23kg/m2 (HR=1.760, 95%CI: 1.253 - 3.042, P＜0.001), LDL-C/HDL-C≥2.37(HR=1.875, 95%CI: 1.520 - 3.007, P＜0.001), extramedullary invasion (HR=2.334, 95%CI: 1.231 - 3.311, P＜ 0.001), complex karyotype (HR=1.987, 95%CI: 1.588 - 3.337, P＜0.001) and non-hematopoietic stem cell transplantation (HR= 2.031, 95%CI: 1.265 - 4.662, P＜0.001) were independent risk factors affecting the RFS time of patients. Conclusion Adult patients with AML-M2 who have high LDL-C/HDL-C and high BMI have a poor prognosis. The levels of LDL-C/HDL-C and BMI can be used as auxiliary markers to predict the prognosis of adult patients with AML-M2.