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Impact of Remnant Cholesterol on Cardiovascular Risk in Diabetes

Daniel Elías-López1,2,3, Benjamin Nilsson Wadström1,2,4, Signe Vedel-Krogh1,2,4

  • 1Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.

Current Diabetes Reports
|October 2, 2024
PubMed

Insights

Elevated remnant cholesterol significantly increases atherosclerotic cardiovascular disease (ASCVD) risk in individuals with diabetes. Therapies targeting remnant cholesterol should also reduce apolipoprotein B (apoB) for effective ASCVD prevention.

Area of Science:

  • Cardiology
  • Endocrinology
  • Metabolic Research

Background:

  • Diabetes mellitus elevates atherosclerotic cardiovascular disease (ASCVD) risk, partly via hyperlipidemia.
  • Residual ASCVD risk persists despite LDL cholesterol reduction, potentially linked to elevated remnant cholesterol.

Purpose of the Study:

  • To elucidate the impact of elevated remnant cholesterol on ASCVD risk in diabetic patients.
  • To review the role of remnant cholesterol as a therapeutic target in diabetes.

Main Methods:

  • Review of preclinical, observational, and Mendelian randomization studies.
  • Analysis of recent clinical trial data on remnant cholesterol-lowering therapies.

Main Results:

  • Strong evidence suggests remnant cholesterol causally increases ASCVD risk.
  • Clinical trials of omega-3 fatty acids and fibrates show conflicting ASCVD prevention results.
  • Therapeutic strategies should aim to lower both remnant cholesterol and apolipoprotein B (apoB).

Conclusions:

  • Elevated remnant cholesterol is a probable driver of ASCVD in diabetes.
  • Effective remnant cholesterol-lowering therapies must also reduce apoB levels to mitigate ASCVD risk.
Abstract

Keywords:
AtherosclerosisHyperglycemiaInsulin ResistanceLipoproteinsTriglyceride-rich LipoproteinsVLDL

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