Remnant Cholesterol Tied with CV Mortality in T2D, CKD & Diabetic Nephropathy Patients
Genetic, observational, and clinical intervention studies indicate that circulating levels of triglycerides and cholesterol transported in triglyceride-rich lipoproteins (remnant cholesterol) can predict cardiovascular events. In a study, researchers have found that remnant cholesterol (remnant-C) was associated with a higher risk of death with CVD in patients with type 2 diabetes (T2D), chronic kidney disease (CKD) and incident diabetic nephropathy.
The study findings were published in The Journal of Clinical Endocrinology & Metabolism on July 22, 2021.
The association between remnant cholesterol and cardiovascular mortality in patients with T2D and incident diabetic nephropathy remains unclear. Therefore, Dr Zhanzheng Zhao and his team conducted a study to examine the association between remnant-C and cardiovascular mortality in patients with T2D, KD stages 3 to 5, and newly diagnosed DN.
The researchers determined the baseline lipid profile and searched for deaths with CVD within 2 years of baseline among 2,282 adults enrolled between January 1, 2015, and December 31, 2016, who had T2D, CKD stage 3 to 5, and newly diagnosed DN. They used adjusted logistic regression models to assess the associations between lipid, especially remnant-C concentration (either as continuous or categorical variables), and risk of cardiovascular mortality.
Key findings of the study:
♦ Upon multivariable-adjusted analyses, , the researchers found that
- Low-density lipoprotein cholesterol (ldl-c) (odds ratio [or], 1.022),
- High-density lipoprotein cholesterol (hdl-c) (or, 0.929),
- Non–HDL-C (OR, 1.024), and
- Remnant-C (OR, 1.115) but not triglycerides were associated with cardiovascular mortality.
♦They also found that 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 associated with cardiovascular mortality (OR, 1.073).
♦ They noted that remnant-C ≥30 mg/dL differentiated patients at greater risk of CVD mortality from those with lower concentrations, particularly for interaction with LDL-C level >100 mg/dL.
♦ They observed patients with higher levels of both remnant-C and LDL-C (OR, 1.696) were at the greatest risk of death with CVD.
The authors concluded, "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."
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