One in Five Atherosclerotic Cardiovascular Disease Events in Individuals With Diabetes Attributed to Elevated Remnant Cholesterol

Benjamin N. Wadström, Kasper M. Pedersen, Anders B. Wulff, Børge G. Nordestgaard*

*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Abstract

Aims
Elevated remnant cholesterol (= the cholesterol carried in triglyceride-rich lipoproteins) is a causal risk factor for atherosclerotic cardiovascular disease (ASCVD) and is common in individuals with diabetes. We tested the hypothesis that ASCVD in individuals with diabetes can be partly attributed to elevated remnant cholesterol.

Materials and Methods
We included 3806 individuals with diabetes identified among 107,243 individuals from the Copenhagen General Population Study and used multivariable adjusted Poisson regression to estimate the fraction of ASCVD attributable to elevated remnant cholesterol. Elevated remnant cholesterol was defined as levels higher than those observed in individuals with non-high-density lipoprotein (non-HDL) cholesterol < 2.6 mmol/L (100 mg/dL), the European guideline goal. Results were replicated in the UK Biobank.

Results
During 15 years of follow-up, 498 patients were diagnosed with ASCVD, 172 with peripheral artery disease, 185 with myocardial infarction and 195 with ischaemic stroke. In individuals with non-HDL cholesterol < 2.6 mmol/L (100 mg/dL) and in all individuals with diabetes, median remnant cholesterol levels were 0.5 mmol/L (20 mg/dL) and 0.8 mmol/L (31 mg/dL). The fraction of events attributable to elevated remnant cholesterol was 19% (95% confidence interval: 10%–28%) for ASCVD, 21% (5%–37%) for peripheral artery disease, 24% (10%–37%) for myocardial infarction and 17% (1%–31%) for ischaemic stroke; in the UK Biobank, corresponding values were 16% (9%–22%), 25% (12%–36%), 17% (8%–25%) and 7% (0%–19%), respectively.

Conclusions
One in five ASCVD events in individuals with diabetes can be attributed to elevated remnant cholesterol. It remains to be determined in clinical trials if remnant cholesterol-lowering therapy may prevent ASCVD.
OriginalsprogEngelsk
Artikelnummere70005
TidsskriftDiabetes/Metabolism Research and Reviews
Vol/bind40
Udgave nummer8
Antal sider12
ISSN1520-7552
DOI
StatusUdgivet - 2024

Bibliografisk note

Funding Information:
We thank the staff and participants from the Copenhagen General Population Study and the UK Biobank for their valuable contributions. We also thank the Independent Research Fund Denmark (Grant 1030-00168B), Novo Nordisk Foundation (Grant NNF21OC0071977), Johan and Lise Boserup Fund, Aase and Ejnar Danielsen Fund, and Herlev and Gentofte Hospital for providing funding. The funders had no role in the design of the study or in the collection, analysis, interpretation of data, writing the manuscript, or the decision to submit the article for publication.

Funding Information:
This work was supported by the Novo Nordisk Foundation (Grant NNF21OC0071977), the Independent Research Fund Denmark (Grant 1030\u201000168B), the Aase Danielsen and Ejnar Danielsen Fund, the Johan Boserup and Lise Boserup Fund and Herlev and Gentofte Hospital. Remnant cholesterol and LDL cholesterol. Funding:

Funding Information:
We thank the staff and participants from the Copenhagen General Population Study and the UK Biobank for their valuable contributions. We also thank the Independent Research Fund Denmark (Grant 1030\u201000168B), Novo Nordisk Foundation (Grant NNF21OC0071977), Johan and Lise Boserup Fund, Aase and Ejnar Danielsen Fund, and Herlev and Gentofte Hospital for providing funding. The funders had no role in the design of the study or in the collection, analysis, interpretation of data, writing the manuscript, or the decision to submit the article for publication.

Publisher Copyright:
© 2024 John Wiley & Sons Ltd.

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