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The role of remnant cholesterol beyond low-density lipoprotein cholesterol in diabetes mellitus

Hu, Xiangming, Liu, Qunzhi, Guo, Xingyuan, Wang, Weimian, Yu, Bingyan, Liang, Beijia, Zhou, Yingling, Dong, Haojian, Lin, Jijin·2022·Cardiovascular Diabetology
DOI 10.1186/s12933-022-01554-0PMC PMC9238255
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Abstract

Background: Previous research has linked elevated low-density lipoprotein cholesterol (LDL-C) and remnant cholesterol (RC) with diabetes mellitus (DM). The present study aims to estimate the RC-related DM risk beyond LDL-C, and to investigate the extent to which the association of RC and DM is mediated via insulin resistance and inflammation. Methods: We enrolled 7308 individuals without previous history of DM into the present study from the China Health and Nutrition Survey. Fasting RC was calculated as total cholesterol minus LDL-C and high-density lipoprotein cholesterol. Subjects were divided into four groups according to their LDL-C (100 mg/dL) and RC (24 mg/dL) levels to evaluate the role of LDL-C vs. RC on DM. A logistic regression analysis was then employed to evaluate the relationships between the discordant/concordant LDL-C and RC and DM. A mediation analysis was undertaken to identify potential mediators. Results: Of all the participants, a total of 625 (8.55%) patients were newly diagnosed with DM. Compared to the high LDL-C/low RC group, the low LDL-C/high RC group was more common in DM patients. After a multivariate adjustment, elevated LDL-C and RC were associated with DM. Moreover, the low LDL-C/high RC group and the high LDL-C/low RC group manifested a 4.04-fold (95% CI 2.93–5.56) and 1.61-fold (95% CI 1.21–2.15) higher risk of DM, relative to those with low LDL-C/low RC. The subgroup analysis indicated that low LDL-C/high RC was more likely to be related to DM in females. Similar results were also shown when the sensitivity analyses were performed with different clinical cut-points of LDL-C. Insulin resistance and inflammation partially mediated the association between RC and DM. Conclusions: Our findings provided evidence for RC beyond the LDL-C associations with DM that may be mediated via insulin resistance and the pro-inflammatory state. In addition, women are more susceptible to RC exposure-related DM.

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Metadata

Authors
Hu, X., Liu, Q., Guo, X., Wang, W., Yu, B., Liang, B., Zhou, Y., Dong, H., & Lin, J.
Venue
Cardiovascular Diabetology
Publisher
Springer Science and Business Media LLC
Published
2022-06-27
Volume
21
Issue
1
ISSN
1475-2840
DOI
10.1186/s12933-022-01554-0
PMC
PMC9238255
Cited by
150
References
4
Language
en
Licence
Funders
  • National Key Research and Development Program of China (No. 2016YFC1301202)
  • Key Project of Natural Science Foundation of Guangdong Province (2017B030311010)
  • Guangzhou Municipal Science and Technology Project (202002030088)

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