medwireNews: Canadian real-world study data show that non-fasting remnant cholesterol (RC) levels are associated with a significantly increased risk for cardiovascular disease (CVD) in people without diabetes, with a similar, but nonsignificant, trend observed in those with diabetes.
Spencer Proctor (University of Alberta, Edmonton) and colleagues reviewed data for 13,631 members (mean age 62 years, 70% women) of the Alberta's Tomorrow Project (ATP) cohort who did not have CVD at baseline or develop diabetes during follow-up. Diabetes was prevalent at baseline, however, in 6.5%.
They report in Diabetic Medicine that mean non-fasting RC levels were significantly higher in participants with versus without diabetes (mean 0.94 vs 0.77 mmol/L).
During the 15-year study period (2000–2015), 1054 (7.7%) participants had incident CVD, including 107 patients with diabetes and 947 without diabetes.
Proctor and team found that, for people without diabetes, each unit increase in non-fasting RC was associated with a significant 22% increased risk for incident CVD, after adjustment for age, sex, statin use, comorbidity, and low-density lipoprotein cholesterol (LDL-C) levels.
They observed a similar trend in the diabetes cohort, but the association did not reach statistical significance, possibly due to the small sample size and lack of power, the authors suggest.
By contrast, LDL-C was significantly inversely associated with CVD risk independent of non-fasting RC. Specifically, each unit increase in LDL-C conferred an 18% and 29% lower risk for CVD in people without and with diabetes, respectively.
“One potential explanation for the observed inverse association between LDL-C and incident CVD is the association with statin use,” say the authors. They found that the highest number of statin users and CVD events were observed in the lowest quartiles of LDL-C. By contrast, statin use was generally associated with less favorable levels of RC as well as high-density lipoprotein cholesterol (HDL-C) and triglycerides.
For HDL-C, each unit increase was associated with significant 29% and 54% lower risks for CVD in the people without and with diabetes, respectively, while triglyceride levels were only significantly associated with CVD in people without diabetes. In this case, each unit increase was associated with a 9% higher CVD risk.
“[Triglyceride] and RC concentrations are highly correlated, and it is logical that [triglyceride] would also present positive associations with CVD,” Proctor et al remark.
They conclude “that non-fasting RC may be of beneficial use for predicting CVD risk in clinical settings, but needs to be further explored in a larger population and for the determination of non-fasting RC reference ranges for implementation in clinical practice.”
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