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Remnant cholesterol and cardiovascular mortality in patients with type 2 diabetes and incident diabetic nephropathy.

PURPOSE
This study examined the association between remnant cholesterol (remnant-C) and cardiovascular mortality in patients with type 2 diabetes (T2D), chronic kidney disease (CKD) stages 3-5 and newly diagnosed diabetic nephropathy (DN).


METHODS
This study determined the baseline lipid profile and searched for deaths with cardiovascular disease (CVD) within 2 years of baseline among 2282 adults enrolled between 01/01/2015 and 31/12/2016 who had T2D, CKD stages 3-5 and newly diagnosed DN. Adjusted Logistic regression models were used to assess the associations between lipid, especially remnant-C concentration (either as continuous or categorical variables), and risk of cardiovascular mortality.


RESULTS
In multivariable-adjusted analyses, low-density lipoprotein cholesterol (LDL-C) (odds ratio [OR]:1.022; 95% confidence interval [CI]: 1.017-1.026, per 10mg/dl), HDL-C (0.929 [0.922-0.936], per 5 mg/dl), Non-HDL-C (1.024 [1.021-1.028], per 10mg/dl), and remnant-C (1.115 [1.103-1.127], per 10mg/dl), but not triglyceride were associated with cardiovascular mortality. 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 also associated with cardiovascular mortality (1.073[1.031-1.116]). Remnant-C ≥30 mg/dl differentiated patients at a higher risk of cardiovascular mortality compared with those with lower concentrations, especially with interaction with LDL-C level >100 mg/dl: the highest risk was found in patients with higher levels of both remnant-C and LDL-C (1.696 [1.613-1.783]).


CONCLUSIONS
In patients with T2D, CKD stages 3-5 and incident DN, remnant-C was associated with 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.