Associations between remnant cholesterol levels and mortality in patients with diabetes

doi:10.4239/wjd.v15.i4.712

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World Journal of Diabetes

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1948-9358

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Diabetes. Apr 15, 2024; 15(4): 712-723
Published online Apr 15, 2024. doi: 10.4239/wjd.v15.i4.712

Associations between remnant cholesterol levels and mortality in patients with diabetes

Deng Pan, Lin Xu, Li-Xiao Zhang, Da-Zhuo Shi, Ming Guo

Deng Pan, Li-Xiao Zhang, Da-Zhuo Shi, Ming Guo, Department of Cardiovascular, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China

Deng Pan, Graduate School, Beijing University of Chinese Medicine, Beijing 100020, China

Deng Pan, Li-Xiao Zhang, Da-Zhuo Shi, Ming Guo, National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China

Lin Xu, Gynecological Department of Traditional Chinese Medicine, China-Japan Friendship Hospital, Beijing 100020, China

Co-first authors: Deng Pan and Lin Xu.

Co-corresponding authors: Da-Zhuo Shi and Ming Guo.

Author contributions: Pan D and Xu L performed statistical analysis; Xu L and Zhang LX retrieved raw data from NHANES; Pan D, Shi DZ designed the study. Pan D, Shi DZ and Guo M wrote the manuscript; Xu L and Guo M acquired the fundings supporting the article. The reasons for designating Xu L and Pan D as co-first authors are as follows: First, the research was performed as a collaborative effort, the effort to retrieve raw data is necessary, and statistical analysis is also essential to finish the article. Second, the two authors cooperated together, Pan D designed the study and Xu L made effort to acquire data. Additionally, Pan D wrote the draft, and two authors managed post-submission matters. We think it is necessary for the article and the two authors contributed with equal importance. Shi DZ and Guo M were co-corresponding authors, the reasons were as follows. Shi DZ inspired the study design and checked the data from NHANES, and confirm the accuracy of the data. Moreover, Shi DZ wrote the draft for the manuscript. Guo M also wrote the draft, and responsible for the revision of the article. In addition, Guo M acquired the fundings and also maintained the raw data. Guo M and Shi DZ are responsible for the data. Hence, we thought Guo M and Shi DZ as co-corresponding authors.

Supported by Project of National Natural Science Foundation of China, No. 82274345 and No. 82104907; and Fundamental Research Funds for the Central public welfare research institutes Grant, No. ZZ13-YQ-016 and No. ZZ13-YQ-016-C1.

Institutional review board statement: The NHANES study was reviewed and approved by the NCHS Research Ethics Review Board.

Clinical trial registration statement: This is a cohort study based on National Health and Nutrition Examination Survey (NHANES) without any intervention and does not require a registration.

Informed consent statement: This is a cohort study based on National Health and Nutrition Examination Survey (NHANES) without any intervention. All participants have provided the consent forms according to NHANES official.

Conflict-of-interest statement: The authors declare they have no conflict of interest.

Data sharing statement: The datasets generated and/or analyzed during the current study are available from https://www.cdc.gov/nchs/nhanes/.

CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.

Corresponding author: Ming Guo, PhD, Deputy Director, Department of Cardiovascular, Xiyuan Hospital of China Academy of Chinese Medical Sciences, No. 1 Xiyuan Cao Chang, Qinglongqiao Street, Haidian District, Beijing 100091, China. mguo@xycacms.ac.cn

Received: December 30, 2023
Peer-review started: December 30, 2023
First decision: January 17, 2024
Revised: January 29, 2024
Accepted: March 7, 2024
Article in press: March 7, 2024
Published online: April 15, 2024
Processing time: 103 Days and 10.5 Hours

ARTICLE HIGHLIGHTS

Research background

Additional research is needed to explore the underlying mechanism of the relationship between remnant cholesterol and mortality.

Research motivation

The optimal remnant cholesterol level for decreasing the risk of all-cause mortality in patients with diabetes was 0.68-1.04 mmol/L. A high level of remnant cholesterol was associated with an increased risk of all-cause and cardiovascular mortality.

Research objectives

The associations of remnant cholesterol with all-cause and cardiovascular mortality were U-shaped. Patients with diabetes in the third quartile of remnant cholesterol (0.68-1.04 mmol/L) had a lower risk of all-cause mortality, and a per standard deviation increase in remnant cholesterol was associated with a higher risk of all-cause and cardiovascular mortality.

Research methods

This cohort study included 4740 patients with diabetes who participated in the National Health and Nutrition Examination Survey from 1999 through 2018. We divided remnant cholesterol into four quartiles, and all participants were followed from the interview date until death or December 31, 2019. Multivariate proportional Cox regression models were used to calculate hazard ratios and 95% confidence intervals. Additionally, a series of subgroup and sensitivity analyses were performed.

Research results

The aim of the present study was to explore the associations of remnant cholesterol with all-cause and cardiovascular mortality in patients with diabetes.

Research conclusions

In current clinical practice, the lipid profile is different between patients with diabetes and nondiabetic patients. However, evidence for the association between remnant cholesterol levels and mortality is lacking.

Research perspectives

Remnant cholesterol is associated with mortality, but the role of remnant cholesterol in patients with diabetes is unclear.