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Remnant cholesterol and cardiovascular mortality in patients with type 2 diabetes and incident diabetic nephropathy

Qu, Bingjie; Zhang, Xiaoxue; Yu, Dahai; Wang, Zheng; Cai, Yamei; Ma, Shuang; Zhao, Zhanzheng; Simmons, David

Authors

Bingjie Qu

Xiaoxue Zhang

Zheng Wang

Yamei Cai

Shuang Ma

Zhanzheng Zhao

David Simmons



Abstract

Context
The association between remnant cholesterol (remnant-C) and cardiovascular mortality in patients with type 2 diabetes (T2D) and incident diabetic nephropathy remains unclear.

Objective
To examinie the association between remnant-C and cardiovascular mortality in patients with T2D, chronic kidney disease (CKD) stages 3 to 5, and newly diagnosed DN.

Methods
This study determined the baseline lipid profile and searched for deaths with cardiovascular disease (CVD) within 2 years of baseline among 2282 adults enrolled between January 1, 2015 and December 31, 2016, who had T2D, CKD stages 3 to 5, and newly diagnosed DN. Adjusted logistic regression models were used to assess the associations between lipid, especially remnant-C concentration (either as continuous or categorical variables), and risk of cardiovascular mortality.

Results
In multivariable-adjusted analyses, low-density lipoprotein cholesterol (LDL-C) (odds ratio [OR], 1.022; 95% CI, 1.017-1.026, per 10 mg/dL), high-density lipoprotein cholesterol (HDL-C) (OR, 0.929; 95% CI, 0.922-0.936, per 5 mg/dL), non–HDL-C (OR, 1.024; 95% CI, 1.021-1.028, per 10 mg/dL), and remnant-C (OR, 1.115; 95% CI, 1.103-1.127, per 10 mg/dL), but not triglycerides were associated with cardiovascular mortality. Atherogenic dyslipidemia (triglycerides > 150 mg/dL [1.69 mmol/L] and HDL-C < 40 mg/dL in men or < 50 mg/dL in women) was also associated with cardiovascular mortality (OR, 1.073; 95% CI, 1.031-1.116). Remnant-C greater than or equal to 30 mg/dL differentiated patients at a higher risk of cardiovascular mortality from those with lower concentrations, especially with interaction with LDL-C level greater than 100 mg/dL: The highest risk was found in patients with higher levels both of remnant-C and LDL-C (OR, 1.696; 95% CI, 1.613-1.783).

Conclusion
In patients with T2D, CKD stages 3 to 5, and incident DN, remnant-C was associated with a higher risk of death with CVD. Different from the general population, the interaction of remnant-C and LDL-C was associated with the highest risk of cardiovascular mortality.

Journal Article Type Article
Acceptance Date Jul 22, 2021
Publication Date Jul 22, 2021
Publicly Available Date Mar 28, 2024
Journal The Journal of Clinical Endocrinology & Metabolism
Print ISSN 0021-972X
Publisher Oxford University Press
Pages 3546-3553
DOI https://doi.org/10.1210/clinem/dgab533
Keywords Type 2 diabetes, Diabetic nephropathy, Cardiovascular diseases, Mortality, Lipids, Remnant cholesterol
Publisher URL https://doi.org/10.1210/clinem/dgab533