The U-shaped association between remnant cholesterol and risk of all-cause and cardiovascular deaths in diabetic adults: Findings from NHANES 1999–2018

• Published in: Nutrition, metabolism, and cardiovascular diseases metabolism, and cardiovascular diseases, 2024-10, Vol.34 (10), p.2282-2288
• Main Authors: Wang, Haixu, Guo, Yuanlin, Zhang, Haibo, Wang, Xiuling, Zheng, Xin
• Format: Article
• Language: English
• Subjects: All-cause deaths; Cardiovascular deaths; Diabetes; NHANES; Remnant cholesterol
• ISSN: 0939-4753; 1590-3729; 1590-3729
• DOI: 10.1016/j.numecd.2024.05.011

We aimed to explore the association between remnant cholesterol (RC) level and risks of all-cause and cardiovascular deaths among American diabetic adults. The data of 4,095 diabetic participants from the National Health and Nutrition Examination Survey (1999–2018) were included for analysis. Deaths were ascertained till December 31, 2019. RC level associated with death was assessed on a continuous scale with restricted cubic splines and by pre-defined quartile groups with Cox regression analysis. After a median follow-up of 6.9 years, 1,060 all-cause and 289 cardiovascular deaths occurred. Association between RC and death was U-shaped, and RC level correlated with the lowest risks of both all-cause and cardiovascular deaths was 0.85 mmol/L. After adjusting for confounders, compared with Quartile 3 (0.66–0.93 mmol/L), hazard ratios for all-cause deaths were 1.43 (95%CI 1.18–1.72, P = 0.0002) in Quartile 1 (≤0.47 mmol/L), 1.20 (95%CI 1.00–1.44, P = 0.05) in Quartile 2 (0.47–0.66 mmol/L), and 1.25 (95%CI 1.05–1.49, P = 0.02) in Quartile 4 (>0.93 mmol/L). Higher risk was also observed for cardiovascular deaths in Quartile 1 (HR 1.66, 95%CI 1.15–2.41, P = 0.007), Quartile 2 (HR 1.39, 95%CI 0.97–2.00, P = 0.08), and Quartile 4 (HR 1.54, 95% CI 1.08–2.19, P = 0.02), as compared with Quartile 3. In US adults with diabetes, low and high levels of RC were associated with increased risks of all-cause and cardiovascular deaths, and the lowest risk was observed at RC level of 0.85 mmol/L. These findings suggested that maintaining appropriate RC level may help reduce risk of death in diabetic patients. •In participants with diabetes, RC level was associated with risk of all-cause and CVD deaths in a U-shaped manner.•The lowest risk for all-cause and CVD deaths was observed at RC level of 0.85 mmol/L.•Assessing RC level in the diabetic population might be beneficial in risk stratification and future intervention.