Abstract
BackgroundThe atherogenicity of remnant cholesterol (RC) has been underlined by recent guidelines, which was linked to coronary artery disease (CAD), especially for patients with diabetes mellitus (DM). This study aimed to examine the prognostic value of plasma RC in the patients with CAD under different glucose metabolism status.MethodsFasting plasma RC were directly calculated or measured in 4331 patients with CAD. Patients were followed for the occurrence of major adverse cardiovascular events (MACEs) and categorized according to both glucose metabolism status [DM, pre-DM, normoglycemia (NG)] and RC levels. Cox proportional hazards model was used to calculate hazard ratios (HRs) with 95% confidence intervals.ResultsDuring a mean follow-up of 5.1 years, 541 (12.5%) MACEs occurred. The risk for MACEs was significantly higher in patients with elevated RC levels after adjustment for potential confounders. No significant difference in MACEs was observed between pre-DM and NG groups (p > 0.05). When stratified by combined status of glucose metabolism and RC, highest levels of calculated and measured RC were significant and independent predictors of developing MACEs in pre-DM (HR: 1.64 and 1.98; both p < 0.05) and DM (HR: 1.62 and 2.05; both p < 0.05). High RC levels were also positively associated with MACEs in patients with uncontrolled DM. .ConclusionsIn this large-scale and long-term follow-up cohort study, data firstly demonstrated that higher RC levels were significantly associated with the worse prognosis in DM and pre-DM patients with CAD, suggesting that RC may be a target for patients with impaired glucose metabolism.
Highlights
The atherogenicity of remnant cholesterol (RC) has been underlined by recent guidelines, which was linked to coronary artery disease (CAD), especially for patients with diabetes mellitus (DM)
The percentage of male patients was less in pre-DM and DM groups while the proportion of smoking patients was higher among individuals with impaired glucose metabolism (p for trend < 0.05)
The Body mass index (BMI), haemoglobin A1c (HbA1c), total cholesterol (TC), and TG were positively associated with the status of glucose metabolism from NG to DM
Summary
The atherogenicity of remnant cholesterol (RC) has been underlined by recent guidelines, which was linked to coronary artery disease (CAD), especially for patients with diabetes mellitus (DM). This study aimed to exam‐ ine the prognostic value of plasma RC in the patients with CAD under different glucose metabolism status. Dyslipidemia is a well-established causal factor for coronary artery disease (CAD), which has been verified by a number of epidemiological and genetic studies, especially in patients with diabetes mellitus (DM) [1, 2]. Despite some previous clinical studies have examined the association between RC and major adverse cardiovascular events (MACEs) in the primary and secondary preventions [10,11,12], data about the prognostic implications of RC and MACEs in CAD patients with different glucose metabolism status is currently lacking. Available studies give no hint on the prognostic value of RC in CAD patients with pre-DM
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