Elevated remnant cholesterol and atherosclerotic cardiovascular disease in diabetes: a population-based prospective cohort study
Authors' conclusion
Elevated remnant cholesterol was associated with increased risk of ASCVD in individuals with diabetes. Remnant cholesterol and low-grade inflammation explained substantial excess risk of ASCVD conferred by diabetes. Whether remnant cholesterol should be used as a treatment target remains to be determined in randomised controlled trials.
Study context
- Population
- White Danish individuals with diabetes (58% statin users), Copenhagen General Population Study (2003–2015)
- Participants
- 4,569 individuals
- Exposure
- Per doubling of remnant cholesterol
- Outcome
- ASCVD: peripheral artery disease, MI and ischaemic stroke, from national Danish health registries
- Follow-up
- Up to 15 years
Methodological detailsnested within the Copenhagen General Population Study, multivariable adjusted
- Nested within the Copenhagen General Population Study
- Multivariable adjusted
Main finding
As reported in the abstract
Peripheral artery disease: HR (95% CI), p
1.6
1.1, 2.3p=0.01
MI: HR (95% CI), p
1.8
1.2, 2.5p=0.002
Ischaemic stroke: HR (95% CI), p
1.5
1.0, 2.1p=0.04
Any atherosclerotic cardiovascular disease (ASCVD): HR (95% CI), p
1.6
1.2, 2.0p=0.0003
Observational data: associations, not effects.
Further findings
Excess risk conferred by diabetes
- Peripheral artery disease
- 2.5-fold
- MI
- 1.6-fold
- Ischaemic stroke
- 1.4-fold
- Any ASCVD
- 1.6-fold
Excess risk explained by elevated remnant cholesterol and low-grade inflammation, respectively
- Peripheral artery disease
- 14% and 8%
- MI
- 26% and 16%
- Ischaemic stroke
- 34% and 34%
- Any ASCVD
- 24% and 18%
- LDL-cholesterol did not explain excess risk, as it was not higher in individuals with diabetes
Original publication
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