OBJECTIVE Remnant cholesterol (remnant-C) predicts atherosclerotic cardiovascular disease, regardless of LDL-cholesterol (LDL-C) levels. This study assessed the associations between remnant-C and cardiovascular outcomes in type 2 diabetes. RESEARCH DESIGN AND METHODS This post hoc analysis of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial used patient (type 2 diabetes >3 months) remnant-C and major adverse cardiovascular event (MACE) data from the study database. The associations between remnant-C and MACEs were evaluated using Cox proportional hazards regression analyses. We examined the relative MACE risk in remnant-C versus LDL-C discordant/concordant groups using clinically relevant LDL-C targets by discordance analyses. RESULTS The baseline analysis included 10,196 participants, with further visit-to-visit variability analysis including 9,650 participants. During follow-up (median, 8.8 years), 1,815 patients (17.8%) developed MACEs. After adjusting for traditional cardiovascular risk factors, each 1-SD increase in remnant-C was associated with a 7% higher MACE risk (hazard ratio [HR] 1.07, 95% CI 1.02–1.12, P = 0.004). In the fully adjusted model, the visit-to-visit remnant-C variability calculated using logSD (HR 1.41, 95% CI 1.18–1.69, P < 0.001) and logARV (HR 1.45, 95% CI 1.22–1.73, P < 0.001) was associated with MACEs. Residual lipid risk (remnant-C ≥31 mg/dL) recognized individuals at a higher MACE risk, regardless of LDL-C concentrations. Within each LDL-C subgroup (>100 or ≤100 mg/dL), high baseline remnant-C was associated with a higher MACE risk (HR 1.37, 95% CI 1.09–1.73, P = 0.007; HR 1.22, 95% CI 1.04–1.41, P = 0.015, respectively). CONCLUSIONS Remnant-C levels were associated with MACEs in patients with type 2 diabetes independent of LDL-C, and visit-to-visit remnant-C variability helped identify those with higher cardiovascular risk.

中文翻译：

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残余胆固醇及其就诊间变异性预测 2 型糖尿病患者的心血管结局：来自 ACCORD 队列的研究结果

目的 残余胆固醇 (remnant-C) 可预测动脉粥样硬化性心血管疾病，而与低密度脂蛋白胆固醇 (LDL-C) 水平无关。本研究评估了 2 型糖尿病中残余 C 与心血管结局之间的关联。研究设 使用 Cox 比例风险回归分析评估残余 C 和 MACE 之间的关联。我们通过不一致分析使用临床相关的 LDL-C 目标检查了残余 C 与 LDL-C 不一致/一致组的相对 MACE 风险。结果 基线分析包括 10,196 名参与者，通过进一步的访问间变异性分析，包括 9,650 名参与者。在随访期间（中位数，8.8 年），1,815 名患者（17.8%）出现了 MACE。在调整传统心血管危险因素后，残余 C 每增加 1-SD 与 MACE 风险增加 7% 相关（风险比 [HR] 1.07，95% CI 1.02–1.12，P = 0.004）。在完全调整的模型中，使用 logSD (HR 1.41, 95% CI 1.18–1.69, P < 0.001) 和 logARV (HR 1.45, 95% CI 1.22–1.73, P < ; 0.001) 与 MACE 相关。无论 LDL-C 浓度如何，残留血脂风险（remnant-C ≥31 mg/dL）识别出具有较高 MACE 风险的个体。在每个 LDL-C 亚组（>100 或 ≤100 mg/dL）中，高基线残余 C 与较高的 MACE 风险相关（HR 1.37，95% CI 1.09–1.73，P = 0.007；HR 1. 22, 95% CI 1.04–1.41, P = 0.015，分别）。结论 Remnant-C 水平与 2 型糖尿病患者的 MACE 相关，独立于 LDL-C，并且访问间的 remnant-C 变异性有助于识别心血管风险较高的患者。