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Association between remnant cholesterol levels and cerebral ischemic stroke in Chinese patients with type 2 diabetes mellitus

Year: 2026
Type: article
Abstract: Background Ischemic stroke (IS) is a severe macrovascular complication in patients with type 2 diabetes mellitus (T2DM). Remnant cholesterol (RC) has been linked to atherosclerotic cardiovascular events; however, relevant data focusing on Chinese patients with T2DM remain limited. This study aimed to explore the association between RC and IS in patients with T2DM. Methods A total of 521 inpatients with T2DM were enrolled and divided into T2DM-only ( n = 309) and T2DM with IS ( n = 212) groups. Demographic characteristics and laboratory data were collected to calculate RC levels. Statistical analyses included Spearman rank correlation, multivariate logistic regression, and restricted cubic spline (RCS) modeling. Results Compared with the T2DM-only group, the T2DM with IS group was older, had a longer diabetes duration, and exhibited higher prevalence of coronary heart disease (CHD), lower extremity arteriosclerosis obliterans, and diabetic nephropathy. Additionally, this group exhibited higher systolic blood pressure (SBP) and RC levels, higher statin usage, and lower low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) levels (all P < 0.05). RC was positively correlated with triglycerides (TG, r = 0.445), total cholesterol (TC, r = 0.356), systolic blood pressure (SBP, r = 0.090), diastolic blood pressure (DBP, r = 0.129), and uric acid (UA, r = 0.119), but negatively correlated with LDL-C ( r =-0.247) ( P < 0.05 for SBP, DBP and UA, P < 0.001 for others). Elevated RC showed an independent cross-sectional association with T2DM with IS (multivariate-adjusted). Subgroup analyses revealed that this cross-sectional association between elevated RC and IS status was more pronounced in participants aged ≥ 65 years than in those aged < 65 years (OR = 501.290, 95%CI: 116.872–2949.301 vs. OR = 30.283, 95%CI: 12.192–91.289). In contrast, no significant interactions were observed for subgroups stratified by sex, CHD, ASO or statin use (all P values for interactions > 0.05). RCS analysis revealed a nonlinear relationship between RC and the odds of IS: the odds increased relatively slowly at lower RC levels, and increased markedly when RC reached approximately 1.07 mmol/L. However, due to the limited sample size for RC level > 1.96 mmol/L, confidence intervals were wider and estimation precision was reduced; thus, the association trend within this range warrants further verification in larger study cohorts. Conclusion Serum RC shows a cross-sectional association with IS in patients with T2DM, and there is a nonlinear relationship between them, with a marked increase in association when RC exceeds approximately 1.07 mmol/L. Our findings highlight the potential clinical relevance of RC as a residual atherosclerotic risk marker among T2DM patients, although prospective studies are needed to validate these observations. Clinical trial number Not applicable.
DOI: 10.1186/s12902-026-02722-z
Language: English
Field: Medicine
Open Access status: gold
Estimated APC paid: $3,190
OpenAlex ID: W7225641926
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