Work

Remnant Cholesterol and Cardiovascular Risk in Adults With Type 1 Diabetes: A Nested Case–Control Study

Year: 2025

Type: article

Abstract: BACKGROUND: Despite advancements in therapeutic strategies, adults with type 1 diabetes (T1D) remain at high risk of cardiovascular disease (CVD). Traditional lipid parameters may not fully account for this residual risk. Remnant cholesterol-found in triglyceride-rich lipoproteins such as VLDL and IDL-has emerged as a potential contributor to atherogenesis but has not been extensively studied in T1D. METHODS: We conducted a nested case-control study within a multicentre Spanish cohort of 2187 adults with T1D. A total of 88 cases with a first CVD event (2010-2024) were matched 1:1 to controls by age, sex, diabetes duration, HbA1c, smoking, hypertension and retinopathy. Remnant cholesterol was calculated as total cholesterol minus HDL-C and LDL-C. Multivariable conditional logistic regression was used to assess associations with CVD. A stratified analysis by LDL-C quartiles was also performed to explore potential effect modification. RESULTS: The mean age of participants was 59.9 ± 12.1 years, 34.7% were female, the median duration of diabetes was 27.9 ± 13.3 years and mean HbA1c was 7.9%±1.3%. Remnant cholesterol levels in the highest quartile (> 28 mg/dL) were independently associated with increased risk of CVD (OR = 4.50; 95% CI: 1.34-15.08; p = 0.015). This association was evident only among individuals with LDL-C ≥ 100 mg/dL, while no significant relationship was observed in those with LDL-C < 100 mg/dL. A linear trend across LDL-C strata further supported a dose-response relationship. HDL-C < 45 mg/dL and triglycerides in the highest quartile were also associated with increased CVD risk. Notably, most participants did not achieve LDL-C targets and 41.4% were untreated. CONCLUSIONS: Elevated remnant cholesterol is an independent predictor of cardiovascular disease in adults with T1D, particularly in those with suboptimally controlled LDL cholesterol. These findings highlight the importance of achieving LDL-C treatment goals and considering remnant cholesterol in cardiovascular risk assessment, supporting the need for targeted lipid-lowering strategies in T1D.

Source: Endocrinology Diabetes & Metabolism

DOI: 10.1002/edm2.70114