Remnant Cholesterol May Predict Cardiovascular Event Risk in Type 2 Diabetes

Remnant cholesterol predicted coronary artery disease events even after adjustment for presence and extent of disease.

Remnant cholesterol may help predict cardiovascular (CV) event risk in patients with type 2 diabetes as well as in patients without diabetes independently from the baseline coronary artery disease (CAD) state, according to a new prospective study.

Results were presented at the American College of Cardiology’s (ACC) 65th Annual Scientific Sessions.

“This is a large and important study. You miss something if you only look at LDL cholesterol,”,” said lead study author Christoph Saely, MD, professor of preventive cardiology and consultant at the Academic Teaching Hospital Feldkirch in Austria.

Remnant cholesterol, which is calculated as total cholesterol minus the sum of LDL cholesterol and HDL cholesterol, may be an important tool, he noted.

Dr Saely and his team examined the power of remnant cholesterol to predict CV events in patients with type 2 diabetes as well as patients without diabetes. A total of 1774 patients were enrolled and all underwent angiography, which makes this study unique, according to Dr Saely. In this way, the investigators were able to know the baseline CAD state at baseline.

“By having their baseline angiogram, we can get a better picture,” said Dr Saely in an interview with Endocrinology Advisor. “We have been following some of them for almost 10 years, and we have an advantage with this kind of population.”

In this study, the mean age of the patients was 63 years and 66% were men. Among, the 1774 patients, 513 had type 2 diabetes, which was diagnosed according to American Diabetes Association criteria. The researchers prospectively recorded CV events over a mean follow-up period of 7.5 years.  

Dr Saely said 32.5% of the patients suffered CV events during follow-up and the event rate was significantly higher in patients with type 2 diabetes compared with those without diabetes (40.5% vs 29.3%; P<.001). The study also demonstrated that remnant cholesterol significantly predicted CAD events in the total study population. 

Results showed that remnant cholesterol can predict CAD events univariately among patients with type 2 diabetes (hazard ratio [HR]=1.20; P=.008) and those without diabetes (HR=1.19; P<.001). Similar results were seen after multivariate adjustment, including adjustment for the presence and extent of baseline CAD (HR=1.21; P=.009, and HR=1.15; P=.002, respectively).

“We found that for 1 standard deviation in remnant cholesterol, your CV risk is increased by about 20%,” said Dr Saely.

Prakash Deedwania, MD, a member of the ACC Prevention of Cardiovascular Disease Committee and clinical professor of medicine at the UCSF Fresno, said these data are intriguing. This may be a simpler way to calculate risk in patients with type 2 diabetes, he noted.

“This term ‘remnant cholesterol’ is a new term,” Dr Deedwania said told Endocrinology Advisor. “This could be an important predictor. Studies will need to be conducted to see if this approach is better than what we have already. We need to see studies that demonstrate that this is better than what we already do with our patients now.”


  1. Saely CH, Zanolin D, Rein P, et al. Remnant Cholesterol Predicts Cardiovascular Event Risk in Patients With Type 2 Diabetes Independently From the Baseline Coronary Artery Disease State. Presented at: ACC 65th Scientific Sessions; April 2-4, 2016; Chicago, IL.