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The association between residual cholesterol to high-density lipoprotein cholesterol ratio and type 2 diabetes risk

Jinting Zhang1, Zhaoxiang Wang1, Qianqian Wang1

  • 1Department of Endocrinology, Kunshan Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu, China.

Frontiers in Endocrinology
|December 4, 2025
PubMed

Insights

Elevated remnant cholesterol to high-density lipoprotein cholesterol ratio (RC/HDL-C) is linked to increased type 2 diabetes (T2D) risk in older adults. This finding suggests RC/HDL-C can aid in predicting T2D in elderly populations.

Area of Science:

  • Cardiovascular Research
  • Metabolic Disease Epidemiology
  • Biomarker Discovery

Background:

  • The remnant cholesterol to high-density lipoprotein cholesterol ratio (RC/HDL-C) is a recognized biomarker for metabolic disturbances.
  • Prior research links elevated RC/HDL-C to cardiovascular, cerebrovascular, and metabolic diseases.
  • Limited longitudinal data exist on RC/HDL-C and type 2 diabetes (T2D) risk, especially in elderly populations.

Purpose of the Study:

  • To investigate the association between RC/HDL-C and incident T2D in Chinese adults.
  • To provide evidence for early T2D prevention and detection strategies.
  • To clarify the role of RC/HDL-C in T2D risk among high-risk elderly individuals.

Main Methods:

  • A prospective follow-up study in Kunshan, China (2018-2021) included 7655 participants aged 60+.
  • Cox proportional hazards models assessed the independent effect of RC/HDL-C on T2D risk.
  • Kaplan-Meier curves and restricted cubic splines (RCS) visualized the relationship between RC/HDL-C and T2D risk.

Main Results:

  • During 3.87 years of follow-up, 783 participants (10.23%) developed T2D.
  • A positive, independent association was found between RC/HDL-C and T2D risk (HR=1.12, P<0.001).
  • RCS analysis indicated a non-linear relationship, and ROC analysis showed modest predictive ability (AUC=0.601).

Conclusions:

  • Elevated RC/HDL-C levels are associated with a higher risk of incident T2D in older adults.
  • RC/HDL-C serves as an independent predictor of T2D in the elderly.
  • RC/HDL-C can potentially enhance risk stratification in existing T2D prediction models.
Abstract

Keywords:
RC/HDL-CT2Dcohort studyelderly populationincident T2D

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