The U-shaped association between remnant cholesterol and risk of all-cause and cardiovascular deaths in diabetic adults: Findings from NHANES 1999–2018

Abstract

Background and aimsWe aimed to explore the association between remnant cholesterol (RC) level and risks of all-cause and cardiovascular deaths among American diabetic adults. Methods and resultsThe data of 4,095 diabetic participants from the National Health and Nutrition Examination Survey (1999–2018) was included for analysis. Deaths were ascertained till December 31, 2019. RC level associated with death was assessed on a continuous scale with restricted cubic splines and by pre-defined quartile groups with Cox regression analysis. After a median follow-up of 6.9 years, 1,060 all-cause and 289 cardiovascular deaths occurred. Association between RC and death was U-shaped, and RC level correlated with the lowest risks of both all-cause and cardiovascular deaths was 0.85 mmol/L. After adjusting for confounders, compared with Quartile 3 (0.66–0.93 mmol/L), hazard ratios for all-cause deaths were 1.43 (95%CI 1.18–1.72, P = 0.0002) in Quartile 1 (≤0.47 mmol/L), 1.20 (95%CI 1.00–1.44, P = 0.05) in Quartile 2 (0.47–0.66 mmol/L), and 1.25 (95%CI 1.05–1.49, P = 0.02) in Quartile 4 (>0.93 mmol/L). Higher risk was also observed for cardiovascular deaths in Quartile 1 (HR 1.66, 95%CI 1.15–2.41, P = 0.007), Quartile 2 (HR 1.39, 95%CI 0.97–2.00, P = 0.08), and Quartile 4 (HR 1.54, 95% CI 1.08–2.19, P = 0.02), as compared with Quartile 3. ConclusionIn US adults with diabetes, low and high levels of RC were associated with increased risks of all-cause and cardiovascular deaths, and the lowest risk was observed at RC level of 0.85 mmol/L. These findings suggested that maintaining appropriate RC level may help reduce risk of death in diabetic patients.