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Remnant Cholesterol and Its Visit-to-visit Variability Predict Cardiovascular Outcomes in Patients with Type 2 Diabetes Mellitus: Findings from the ACCORD Cohort

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posted on 14.07.2022, 15:16 authored by Liyao Fu, Shi Tai, Jiaxing Sun, Ningjie Zhang, Ying Zhou, Zhenhua Xing, Yongjun Wang, Shenghua Zhou


Objective: Remnant cholesterol (remnant-C) predicts atherosclerotic cardiovascular disease, regardless of LDL cholesterol (LDL-C) levels. This study assessed the associations between remnant-C and cardiovascular outcomes in type 2 diabetes mellitus. 

Research design and methods: This post-hoc analysis of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial used patient (type 2 diabetes >3 months) remnant-C and major adverse cardiovascular event (MACE) data from the study database. The associations between remnant-C and MACEs were evaluated using Cox proportional hazards regression analyses. We examined the relative MACE risk in remnant-C versus LDL-C discordant/concordant groups using clinically relevant LDL-C targets by discordance analyses.

Results: The baseline analysis included 10,196 participants, with further visit-to-visit variability analysis including 9650 participants. During follow-up (median, 8.8 years), 1815 (17.8%) patients developed MACEs. After adjusting for traditional cardiovascular risk factors, each 1-SD increase in remnant-C was associated with a 7% higher MACE risk (HR=1.07, 95% CI: 1.02-1.12; P=0.004). In the fully adjusted model, the visit-to-visit remnant-C variability calculated using logSD (HR=1.41, 95% CI: 1.18-1.69, P<0.001) and logARV (HR=1.45, 95% CI: 1.22-1.73, P<0.001) was associated with MACEs. Residual lipid risk (remnant-C ³31 mg/dL) recognized individuals at a higher MACE risk, regardless of LDL-C concentrations. Within each LDL-C subgroup (>100 or ≤100 mg/dL), high baseline remnant-C was associated with a higher MACE risk (HR=1.37, 95% CI: 1.09-1.73; P=0.007; HR=1.22, 95% CI: 1.04-1.41; P=0.015, respectively).

Conclusions: Remnant-C levels were associated with MACEs in type 2 diabetic patients independent of LDL-C, and visit-to-visit remnant-C variability helped identify those with higher cardiovascular risk.


This research was supported by the National Natural Science Foundation of China (81801394 to Shi Tai) and the Natural Science Foundation of Hunan Province (2019JJ50878 to Shi Tai).