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Aims: Very few cohort studies are available about the relation between remnant cholesterol (RC) and diabetes. Based on a prospective cohort survey, this research aimed at investigating if high RC was related to a future diabetes risk in the Chinese population, as well as to compare the association between RC, high‐density lipoprotein cholesterol (HDL‐C), low‐density lipoprotein cholesterol (LDL‐C), total cholesterol (TC), triglycerides (TG), TG/HDL‐C, LDL‐C/HDL‐C, TC/HDL‐C, and non‐high‐density lipoprotein cholesterol (non‐HDL‐C), and future diabetes risk. Materials and Methods: 6,700 baseline normoglycemic participants of the REACTION study's Beijing center were recruited in 2011–2012 and followed up in 2015. Multivariate Cox regression analyses were performed to explore the relationship of RC, HDL‐C, LDL‐C, TC, TG, LDL‐C/HDL‐C, TG/HDL‐C, TC/HDL‐C, and non‐HDL‐C and a future diabetes risk. Results: After potential confounders were adjusted for, only RC (HR 1.134, 95% CI 1.016–1.267, P = 0.025) was positively related to a future diabetes risk, and only HDL‐C (HR 0.728, 95% CI 0.578–0.918, P = 0.007) was negatively related to a future diabetes risk. The rest of the lipid parameters were not related to a future risk of diabetes. Sensitivity and stratification analyses revealed that the relation between RC and future diabetes risk was stable. RC and future diabetes risk were still positively correlated even when the HDL‐C was ≥1.04 mmol/L (HR 1.167, 95% CI 1.050–1.297, P = 0.004). Conclusions: It was RC, but not other lipid parameters, that was independently and positively related to a future risk of diabetes among the Chinese general population. Moreover, the relationship between RC and diabetes risk was stable, even with appropriate levels of HDL‐C. [ABSTRACT FROM AUTHOR]

Background: Not many large‐sample investigations are available that compare the potency of the relationship of remnant cholesterol (RC) and other lipid parameters with diabetes and prediabetes. The goals of our study are to discover the relationship between RC and prediabetes, diabetes, and insulin resistance (IR) and to investigate RC, high‐density lipoprotein cholesterol (HDL‐C), non‐HDL‐C, triglycerides (TG), low‐density lipoprotein cholesterol (LDL‐C), total cholesterol (TC), TC/HDL‐C, LDL‐C/HDL‐C, and TG/HDL‐C, which are the lipid parameters that are most positively related to diabetes, prediabetes, and IR. Methods: This research enrolled 36 684 subjects from China's eight provinces. We employed multiple logistic regression analysis for testing the relationship between lipid parameters and diabetes, prediabetes, and IR. Results: After adjusting for potential confounders, and comparing the results with other lipid parameters, the positive relationship between RC and diabetes (odds ratio [OR] 1.417, 95% confidence interval [CI]: 1.345–1.492), prediabetes (OR 1.555, 95% CI: 1.438–1.628), and IR (OR 1.488, 95% CI: 1.404–1.577) was highest. RC was still related to diabetes, prediabetes, and IR even when TG <2.3 mmol/L (diabetes: OR 1.256, 95% CI: 1.135–1.390; prediabetes: OR 1.503, 95% CI: 1.342–1.684; and IR: OR 1.278, 95% CI: 1.140–1.433), LDL‐C <2.6 mmol/L (diabetes: OR 1.306, 95% CI: 1.203–1.418; prediabetes: OR 1.597, 95% CI: 1.418–1.798; and IR: OR 1.552, 95% CI: 1.416–1.701), or HDL‐C ≥1 mmol/L (diabetes: OR 1.456, 95% CI: 1.366–1.550; prediabetes: OR 1.553, 95% CI: 1.421–1.697; and IR: OR 1.490, 95% CI: 1.389–1.598). Conclusion: RC is more positively related to diabetes, prediabetes, and IR than conventional lipids and lipid ratios in the general population, the relationships between RC and diabetes, prediabetes, and IR are stable, even if HDL‐C, LDL‐C, or TG are at appropriate levels. [ABSTRACT FROM AUTHOR]

Objectives: Obesity and hypercholesterolemia are linked to unfavor clinical outcomes. Recent studies declared the paradox that high body mass index (BMI) and serum cholesterol were independently connected to better clinical outcome of immune checkpoint inhibitors (ICIs) monotherapy in non‐small cell lung cancer (NSCLC). The aim of the study is to investigate the prognosis of BMI and serum cholesterol in ICIs‐based therapy. Methods: This is a retrospective study of 95 NSCLC patients treated with ICIs‐based therapy at the Department of Oncology and Lung Cancer Center of China‐Japan Friendship Hospital. Treatment efficacy was assessed using durable clinical benefit (DCB) versus nondurable benefit (NDB), best response (active vs. nonactive), and progression‐free survival (PFS). The prognostic value of BMI, LDL‐C, and RC was determined by multivariate regression analyses, while controlling for confounding factors including age, gender, diabetes status, smoking history, and statin usage. BMI was considered a confounding factor in the analysis when examining the impact of lipoproteins. Results: In our study, we found that in the whole group, BMI ≥25 kg/m2 was linked to a higher risk of poor therapeutic response (OR = 5.92, 95% CI 1.99–19.51, p.val = 0.002) and shorter progression‐free survival (HR = 3.00, 95% CI 1.59–5.68, p.val = 0.001). In addition, low levels of RC were associated with better therapeutic response (OR = 0.12, 95% CI 0.02–0.64, p.val = 0.019), while low levels of serum LDL‐C were found to predict longer PFS (HR = 0.40, 95% CI 0.19–0.82, p.val = 0.012). These associations were consistent in advanced NSCLC patients receiving ICIs and chemotherapy. Conclusions: Our study suggest that BMI ≥25 kg/m2 and elevated levels of apoB‐containing lipoproteins, including LDL‐C and RC, could potentially serve as useful prognostic markers for predicting poor treatment outcomes in advanced NSCLC patients treated with the combination of chemotherapy and ICIs. [ABSTRACT FROM AUTHOR]

Objective: Several studies have illustrated that elevated RC levels are related to a heightened risk of acute ischemic stroke (AIS). Our research aimed to explore the correlation between RC levels and poor prognosis after a 90‐day interval in AIS patients. Methods: A total of 287 individuals were enrolled in the study, the primary outcome was defined as poor prognosis. RC was derived by the exclusion of low‐density lipoprotein cholesterol (LDL‐C) and high‐density lipoprotein cholesterol (HDL‐C) from total cholesterol (TC). Results: Following the screening process, 253 AIS patients were included in the study, presenting a median age of 66[57, 75] years. Upon stratifying RC levels into quartiles, those in the top quartile faced a greater likelihood of diabetes diagnosis (42.86%, p =.014) and experienced a higher rate of unfavorable outcomes after 90 days (36.51%, p =.001). After accounting for confounding factors, the correlation between the fourth quartile of RC levels and the amplified likelihood of poor prognosis remained significant (odds ratio (OR) 8.471, 95% confidence interval (CI) (1.841, 38.985); p =.006). Analysis of subgroups unveiled a notable correlation between higher RC levels and poor 90‐day prognosis, particularly in individuals with elevated NIHSS scores (p =.044). A progressively increasing 90‐day risk of poor prognosis after an RC greater than 0.38 mmol/L was visualized by restricted cubic spline plots (p‐overall =.011). Conclusions: Including RC as a contributing element may refine the prediction of poor 90‐day prognosis for AIS patients. Integrating RC with traditional risk factors can potentially enhance the predictive value for cerebrovascular disease. [ABSTRACT FROM AUTHOR]

Background: With the increasing incidence of diabetes worldwide, patients diagnosed with diabetes has been getting younger. Previous studies have shown that high remnant cholesterol (RC) level leads to an increased risk of cardiovascular disease events. However, the relationship between RC levels and newly diagnosed early‐onset type 2 diabetes mellitus (T2DM) is unknown. This study aimed to explore the association between RC and newly diagnosed early‐onset T2DM. Methods: A total of 606 patients newly diagnosed with early‐onset T2DM and 619 gender‐matched subjects with normal blood glucose levels were retrospectively enrolled in this study. All T2DM patients showed onset age of 18–40 years. Binary logistic regression analysis was performed to analyze independent risk factors and receiver operating characteristic (ROC) analysis was used to explore the predictive value of RC and other unconventional lipids. Moreover, the correlation between RC and insulin resistance in patients with newly diagnosed early‐onset T2DM was also examined with binary logistic regression analysis and Spearman correlation analysis. Results: Increased RC level was an independent risk factor for early‐onset T2DM (p <.05). The area under the curve on ROC analysis of RC was 0.805, 95% confidence interval (CI) was 0.781 ~ 0.826, sensitivity was 82.18% and specificity was 66.24%, which showed higher predictive value than those of triglyceride/high‐density lipoprotein cholesterol (TG/HDL‐C) ratio and total cholesterol (TC)/HDL‐C ratio. Cutoff value of RC was 0.32 mmol/L. Level of RC in early‐onset T2DM patients with moderate or severe insulin resistance was significantly higher than that in patients with mild insulin resistance (p <.0001). No difference in RC levels was found between patients with moderate and severe insulin resistance (p >.05). RC was still correlated with insulin resistance after adjusting the conventional lipid parameters (TG, TC, HDL‐C, and low‐density lipoprotein cholesterol) using partial correlation analysis. Conclusion: RC level was higher in patients with early‐onset T2DM and was correlated to the degree of insulin resistance as well. Patients aged 18–40 years with RC >0.32 mmol/L showed an increased risk of developing T2DM. [ABSTRACT FROM AUTHOR]

Physical activity (PA) has the potential to bring about favourable changes in plasma lipid profile. However, the relationship between PA and remnant cholesterol (RC) remains unclear. We aimed to study the link between PA and RC using the database of the 2007–2020 National Health and Nutrition Examination Survey (NHANES). PA was categorized based on Physical Activity Guidelines for Americans. A multivariate linear regression model was used to determine the correlations between PA and RC. The study involved a total of 18,396 participants and revealed that individuals whose PA met the guidelines by engaging in moderate‐intensity PA at least 150 min per week had lower body mass index and showed decreased levels of triglyceride, TC, and haemoglobin A1c compared to those who were physically inactive, exercising <150 min per week. Participants whose intensity of PA meets PA guidelines had a lower level of RC than those who did not met PA guidelines (β = −1.3, 95% confidence interval [CI]: −1.9 to −0.7, p < 0.001), even after adjusting for confounders. During subgroup analysis, we observed that race (pinteraction = 0.0089) emerged as a significant factor of interaction. [ABSTRACT FROM AUTHOR]

Background: There are still many uncertainties in the association between lipid profile and postcoronary artery bypass grafting (CABG) outcomes. Although simplifying the association to linear equations makes it understandable but cannot explain many findings. Hypothesis: There is a nonlinear associatin between lipid profile indices and adverse outcomes after CABG. Methods: A total of 17 555 patients who underwent isolated CABG between 2005 and 2016 were evaluated. During the median follow‐up of 75.24 months, the Restricted Cubic Splines (RCS) estimated from the Cox regression model adjusted for all possible confounders was applied to show a nonlinear relationship of lipid profile contents with the "ln hazard ratio" of mortality and major cerebro‐cardiac events (MACCE). Results: The relationship between LDL‐C and HDL‐C with all‐cause mortality was nonlinear (nonlinear p were.004 and <.001, respectively). The relationship between remnant cholesterol and all‐cause mortality was linear (linearity p =.023). Among men, those in the highest LDL‐C level (Q4, LDL‐C > 114) and those in the lowest HDL‐C level (Q1, HDL‐C < 30) showed a significantly higher risk of all‐cause mortality compared to other groups (compared with Q3, LDL‐C Q4, HR = 1.16, 95% confidence interval [CI]:1.02–1.26, p =.014; HDL‐C Q1, HR = 1.14, 95% CI: 1.01–1.31, p =.041). Female patients in the lowest HDL‐C level (Q1, HDL‐C < 30) showed a significantly higher (compared with Q3, HR = 1.14, 95% CI:1.01–1.31, p =.028) and those in the highest HDL‐C level (Q4, HDL‐C > 43) showed a significantly lower (compared with Q3, HR = 0.74, 95% CI:0.58–0.98, p =.019) risk of all‐cause mortality. Conclusion: Determining a universal cut off for components of lipid profile may be misleading and should better be revised. Extreme values (very low or very high) for HDL‐C and LDL‐C have different effects on cardiovascular outcomes. [ABSTRACT FROM AUTHOR]

Background: The association between remnant cholesterol (RC) and diabetes remains unclear because of limited study and data. This study attempted to explore the association between RC and diabetes in a large sample, multicenter general population. Methods: The current study included 36 684 participants from eight provinces across China. Subjects were quartered according to the RC quartile. Logistic regression analysis was used to evaluate the association between RC and diabetes. Results: After adjusting for potential confounding factors, RC was still significantly associated with diabetes (Q4: odds ratio [OR]:1.147, 95% confidence interval [CI]: 1.049–1.254, p =.003). In addition, RC and diabetes were still significantly associated when triglycerides (TG) were <1.7 mmol/L (Q4: OR: 1.155, 95% CI: 1.005–1.327, p =.042), low‐density lipoprotein cholesterol (LDL‐C) <3.4 mmol/L (Q4: OR: 1.130, 95% CI: 1.011–1.264, p =.032), or HDL‐C (high‐density lipoprotein cholesterol) ≥1.0 mmol/L (Q4: OR: 1.116, 95% CI: 1.007–1.237, p =.037). In the stratification analysis, elevated RC was significantly associated with diabetes in subjects with systolic blood pressure (SBP) <140 mm Hg and diastolic blood pressure (DBP) <90 mm Hg, 60 ≤ estimated glomerular filtration rate (eGFR) ≤90 ml/min per 1.73 m2, younger than 55 years old and female. Conclusion: In the Chinese community, RC is significantly correlated with diabetes, even when TG, LDL‐C, or HDL‐C were controlled within the appropriate range recommended by the guidelines. [ABSTRACT FROM AUTHOR]

Background: The atherogenic effect of remnant cholesterol is being increasingly acknowledged. This study aimed to explore the association of discordance between remnant cholesterol and low-density lipoprotein cholesterol with stroke onset using 2 Chinese national cohorts., Methods and Results: We studied 11 139 participants from CHARLS (China Health and Retirement Longitudinal Study) and 5993 participants from CHNS (China Health and Nutrition Survey) aged 45 years or older. The discordance between remnant cholesterol and low-density lipoprotein cholesterol was defined using the difference in percentile units (>15 units). There were 988 (8.9%) and 128 (2.1%) stroke events reported during follow-up in the 2 cohorts. Elevated remnant cholesterol was significantly associated with a higher risk of total stroke in 2 cohorts. After adjusting for remnant cholesterol level, the discordantly high remnant cholesterol group was significantly associated with an increased stroke risk (CHARLS: subdistribution hazard ratio [sHR], 1.31 [95 CI, 1.10-1.55]; CHNS: sHR, 1.84 [95 CI, 1.15-3.08]) compared with the discordantly low group. Consistent results were shown even among those with optimal low-density lipoprotein cholesterol level., Conclusions: The discordance between remnant cholesterol and low-density lipoprotein cholesterol, representing the intraindividual discrepancy, is significantly associated with stroke onset among Chinese adults.

Background: The metabolic syndrome phenotype of individuals with obesity is characterized by elevated levels of triglyceride-rich lipoproteins and remnant particles, which have been shown to be significantly atherogenic. Understanding the association between adipokines, endogenous hormones produced by adipose tissue, and remnant cholesterol (RC) would give insight into the link between obesity and atherosclerotic cardiovascular disease., Methods and Results: We studied 1791 MESA (Multi-Ethnic Study of Atherosclerosis) participants who took part in an ancillary study on body composition with adipokine levels measured (leptin, adiponectin, and resistin) at either visit 2 or visit 3. RC was calculated as non-high-density lipoprotein cholesterol minus low-density lipoprotein cholesterol, measured at the same visit as the adipokines, as well as subsequent visits 4 through 6. Multivariable-adjusted linear mixed-effects models were used to assess the cross-sectional and longitudinal associations between adipokines and log-transformed levels of RC. Mean±SD age was 64.5±9.6 years; mean±SD body mass index was 29.9±5.0 kg/m 2 ; and 52.0% were women. In fully adjusted cross-sectional models that included body mass index, diabetes, low-density lipoprotein cholesterol, and lipid-lowering therapy, for each 1-unit increment in adiponectin, there was 14.6% (95% CI, 12.2-16.9) lower RC. With each 1-unit increment in leptin and resistin, there was 4.8% (95% CI, 2.7-7.0) and 4.0% (95% CI, 0.2-8.1) higher RC, respectively. Lower adiponectin and higher leptin were also associated with longitudinal increases in RC levels over median follow-up of 5 (interquartile range, 4-8) years., Conclusions: Lower adiponectin and higher leptin levels were independently associated with higher levels of RC at baseline and longitudinal RC increase, even after accounting for body mass index and low-density lipoprotein cholesterol.

Background: Greater lipid variability may cause adverse health events among diabetic patients. We aimed to examine the effect of lipid variability on the risk of diabetic microvascular outcomes among type 2 diabetes mellitus patients. Methods: We assessed the association between visit‐to‐visit variability (measured by variability independent of mean) in high‐density lipoprotein (HDL) cholesterol, low‐density lipoprotein‐cholesterol (LDL), triglyceride, and remnant cholesterol (RC) measurements among participants involved in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study and the risk of incident microvascular outcomes, including nephropathy, neuropathy, and retinopathy. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted for potential confounders. Results: There were 2400, 2470, and 2468 cases of nephropathy, neuropathy, and retinopathy during a follow‐up period of 22 600, 21 542, and 26 701 person‐years, respectively. Higher levels of HDL, triglyceride, and RC variability were associated with an increased risk of incident nephropathy and neuropathy. Compared with the lowest quartile, the fully adjusted HRs (95% CI) for the highest quartile of HDL, triglyceride, and RC variability for nephropathy risk were 1.57 (1.22, 2.01), 1.50 (1.18, 1.92), and 1.40 (1.09, 1.80), respectively; and for neuropathy, the corresponding risks were 1.36 (1.05, 1.75), 1.47 (1.14, 1.91), and 1.35 (1.04, 1.74), respectively. Null association was observed between LDL variability and all microvascular complications. Additionally, all associations of variability in the other lipids with retinopathy risk were null. Conclusion: Among individuals with type 2 diabetes mellitus, HDL, triglyceride, and RC variability were associated with increased risks of nephropathy and neuropathy but not retinopathy. Trial registration: ClinicalTrials.gov., no. NCT00000620. [ABSTRACT FROM AUTHOR]

Background: Bleeding risk brought by intensive lipid-lowering therapy and low low-density lipoprotein cholesterol is concerning, while evidence regarding the relationship between remnant cholesterol and bleeding is frightening. This study aimed to investigate the association between remnant cholesterol at admission and an in-hospital bleeding event after acute ischemic stroke or transient ischemic attack (TIA)., Methods and Results: A total of 3222 eligible patients admitted to Shanghai Huashan Hospital between 2015 and 2021 with complete lipid data were analyzed. Patients were classified into low (<20.0 mg/dL), moderate (20.0-29.9 mg/dL), and high (≥30 mg/dL) groups by remnant cholesterol. The mean age of patients was 63.0± 13.1 years, including 2301 (71.4%) men and 651 (20.2%) with TIA. The median (interquartile range) of remnant cholesterol was 18.6 (13.5-25.9) mg/dL. After adjustment for confounding variables, patients with low remnant cholesterol had a higher risk of bleeding events (odds ratio, 2.56 [95% CI, 1.12-6.67]) than those with moderate remnant cholesterol. The high remnant cholesterol group was not significantly associated with bleeding risk. Combined assessment of low-density lipoprotein cholesterol and remnant cholesterol further identified patients with the highest risk of bleeding events., Conclusions: Low remnant cholesterol levels were associated with bleeding events during the acute stage of ischemic stroke and TIA. The assessment of remnant cholesterol could inform the bleeding risk during hospitalization both for patients and physicians in clinical practice.

Background: Atherosclerosis is triggered by the retention of apolipoprotein B-containing lipoproteins by proteoglycans. In addition to low-density lipoprotein, remnant lipoproteins have emerged as pivotal contributors to this pathology, particularly in the context of insulin resistance and diabetes. We have previously reported antiatherogenic properties of a monoclonal antibody (chP3R99) that recognizes sulfated glycosaminoglycans on arterial proteoglycans., Methods and Results: Solid-phase assays demonstrated that chP3R99 effectively blocked >50% lipoprotein binding to chondroitin sulfate and vascular extracellular matrix in vitro. The preperfusion of chP3R99 (competitive effect) resulted in specific antibody-arterial accumulation and reduced fluorescent lipoprotein retention by ~60% in insulin resistant JCR:LA- cp rats. This competitive reduction was dose dependent (25-250 μg/mL), effectively decreasing deposition of cholesterol associated with lipoproteins. In a 5-week vaccination study in insulin resistant rats with (200 μg subcutaneously, once a week), chP3R99 reduced arterial lipoprotein retention, and was associated with the production of antichondroitin sulfate antibodies (Ab3) able to accumulate in the arteries (dot-blot). Neither the intravenous inoculation of chP3R99 (4.5 mg/kg), nor the immunization with this antibody displayed adverse effects on lipid or glucose metabolism, insulin resistance, liver function, blood cell indices, or inflammation pathways in JCR:LA -cp rats., Conclusions: Both acute (passive) and long-term administration (idiotypic cascade) of chP3R99 antibody reduced low-density lipoprotein and remnant lipoprotein interaction with proteoglycans in an insulin-resistant setting. These findings support the innovative approach of targeting proatherogenic lipoprotein retention by chP3R99 as a passive therapy or as an idiotypic vaccine for atherosclerosis.

Background: We aimed to assess whether remnant cholesterol concentration and variability predict the progression of diabetic nephropathy (DN) and severe diabetic retinopathy (SDR) in type 1 diabetes. Methods: This observational prospective study covered 5150 FinnDiane Study participants. Remnant cholesterol was calculated as total cholesterol – LDL cholesterol – HDL cholesterol and variability as the coefficient of variation. DN category was based on consensus albuminuria reference limits and the progression status was confirmed from medical files. SDR was defined as retinal laser treatment. For 1338 individuals, the severity of diabetic retinopathy (DR) was graded using the ETDRS classification protocol. Median (IQR) follow‐up time was 8.0 (4.9–13.7) years for DN and 14.3 (10.4–16.3) for SDR. Results: Remnant cholesterol (mmol L−1) was higher with increasing baseline DN category (P < 0.001). A difference was also seen comparing non‐progressors (0.41 [0.32–0.55]) with progressors (0.55 [0.40–0.85]), P < 0.001. In a Cox regression analysis, remnant cholesterol predicted DN progression, independently of diabetes duration, sex, HbA1c, systolic blood pressure, smoking, BMI, estimated glucose disposal rate and estimated glomerular filtration rate (HR: 1.51 [1.27–1.79]). Remnant cholesterol was also higher in those who developed SDR (0.47 [0.36–0.66]) than those who did not (0.40 [0.32–0.53]), P < 0.001, and the concentration increased stepwise with increasing DR severity (P < 0.001). Regarding SDR, the HR for remnant cholesterol was 1.52 (1.26–1.83) with the most stringent adjustment. However, remnant cholesterol variability was not independently associated with the outcomes. Conclusions: Remnant cholesterol concentration, but not variability, predicts DN progression and development of SDR. However, it remains to be elucidated whether the associations are causal or not. [ABSTRACT FROM AUTHOR]

Background: Evidence for the relationship between remnant cholesterol (RC) and incident atrial fibrillation (AF) risk remains sparse and limited., Methods and Results: Participants were enrolled between 2006 and 2010 and followed up to 2021. The multivariable Cox proportional hazards model was used to examine the relationship between RC quartiles and risk of incident AF. Subgroup analyses and sensitivity analyses were performed to explore the potential modification of the association and the robustness of the main findings. A total of 422 316 participants (mean age, 56 years; 54% women) were included for analyses. During a median follow-up of 11.9 years (first quartile-third quartile, 11.6-13.2 years), there were 24 774 AF events documented with an incidence of 4.92 events per 1000 person-years (95% CI, 4.86-4.98). Participants in higher RC quartiles had a lower risk of incident AF than those in the lowest quartile (first quartile): hazard ratio (HR)=0.96 (95% CI, 0.91-1.00) for second quartile; HR=0.92 (95% CI, 0.88-0.96) for third quartile; and HR=0.85 (95% CI, 0.81-0.89) for fourth quartile ( P for trend <0.001). The association between RC quartiles and risk of incident AF was stronger in participants aged ≥65 years, in men, and in participants without history of diabetes when compared with control groups ( P <0.001 for interaction)., Conclusions: On the basis of data from this large-scale prospective cohort study, elevated RC was associated with a lower risk of incident AF.

Background: The correlation between remnant cholesterol (RC) and urinary albumin to creatinine ratio (UACR) has not been illustrated. The present study aims to explore the correlation between RC levels and UACR in Chinese community adults. Methods: This study included 35 848 participants from a cohort study (REACTION). The UACR data were divided into three groups: UACR <10 mg/g, 10 ≤UACR<30 mg/g, and UACR ≥30 mg/g groups. RC was divided into two groups, according to the 75th percentile: <75% group and ≥75% group. Multiple logistic regression analysis was used to evaluate the correlation between RC and UACR. Results: The RC exhibited an adjusted odds ratio that was significant in models 1‐5. Although all confounders were corrected in model 5, RC and UACR were still significantly correlated， and the correlation was more significant in females，when compared to males (odds ratio [OR]: 1.117, 95% CI: 1.063‐1.176, P < 0.001 for all subjects; OR: 1.092, 95% CI: 1.128‐1.161, P = 0.004 for females; and OR: 1.085, 95% CI: 0.998‐1.194, P = 0.088 for males). The RC was significantly correlated with UACR for subjects with 5.6 ≤ fasting blood glucose < 7.0 or 7.8 ≤ post‐load blood glucose < 11.1 mmol/L, 24 ≤ body mass index (BMI) < 28 kg/m2, 120 ≤ systolic blood pressure < 140 and/or 80 ≤ diastolic blood pressure < 90 mm Hg. Conclusions: In the Chinese community, RC is highly correlated with UACR, and the correlation is more significant in females compared with males. At higher RC levels, patients with critical values of blood pressure, BMI and blood glucose have a more significant correlation between RC and UACR. [ABSTRACT FROM AUTHOR]

Abstract: Background: Premature myocardial infarction (≤40 years) represents a rare disease with a distinct risk factor profile and a lipid phenotype that is characterized by a predominance of elevated triglyceride‐rich lipoproteins. So far high‐density and low‐density lipoproteins remain the primary targets for risk stratification and treatment evaluation in coronary artery disease, but this strategy might be insensitive in patients with premature myocardial infarction. Aim: Aim of this study was to investigate the predictive value of different lipid fractions on long‐term cardiovascular outcome in patients with premature myocardial infarction. Methods: We prospectively enrolled 102 consecutive AMI survivors (≤40 years) in this prospective multicentre study and investigated the influence of the familial combined hypercholesterolaemia phenotype and a corresponding multimarker panel of different lipid fractions on cardiovascular outcome. Results: Total cholesterol, non‐HDL cholesterol, remnant cholesterol and Apo B lipoprotein were significantly higher in patients experiencing MACE as compared to those who did not. The familial combined hypercholesterolaemia phenotype was associated with an unfavourable cardiovascular outcome even after adjustment for potential cofounders (adjusted HR 3.04,95% CI, 1.26‐7.34, P = 0.013). Remnant cholesterol revealed the strongest association with MACE (adj.HR 1.94, 95%CI. 1.30‐2.99, P = 0.001). Interestingly LDL and HDL revealed no significant impact on cardiovascular outcome in this study cohort. Conclusion: Non‐HDL and remnant cholesterol are strongly associated with an unfavourable outcome in patients with premature myocardial infarction and might be the preferred treatment target for lipid‐lowering therapy. [ABSTRACT FROM AUTHOR]

Background: Hypertriglyceridemia prevalence is increasing as more individuals become obese, and chylomicronemia risk factors for the individual and community have not been described previously.Objective: To describe chylomicronemia risk factors in the general population for individuals and community.Methods: A total of 108 711 individuals from the Copenhagen General Population Study were grouped as unlikely chylomicronemia (nonfasting triglycerides <2 mmol L-1 (177 mg dL-1 )), possible chylomicronemia (2-4.99 mmol L-1 (177-442 mg dL-1 )), probable chylomicronemia (5-9.99 mmol L-1 (443-885 mg dL-1 )) and definite chylomicronemia (≥10 mmol L-1 (≥ 886 mg dL-1 )). Relative risk (RR) from Poisson regression ranked dichotomized chylomicronemia risk factors for individuals, and population attributable fractions (PAF) for the community: type 2 diabetes, alcohol intake, obesity, fat intake, hypothyroidism, kidney function, education, sedentary lifestyle, menopause and hormone replacement (women).Results: For women and men, chylomicronemia was unlikely in 81% and 64%, possible in 18% and 33%, probable in 1% and 3% and definite in 0.03% and 0.14%, respectively. For the individual, the three top-ranked risk factors for probable/definite versus unlikely chylomicronemia in women were type 2 diabetes (RR: 4.21; 95% confidence interval: 3.30-5.36), menopause (RR: 3.74; 2.62-5.36) and obesity (RR: 3.44; 2.81-4.21). Corresponding top-ranked risk factors in men were obesity (RR: 3.86; 3.46-4.30), type 2 diabetes (RR: 1.88; 1.61-2.19) and reduced kidney function (RR: 1.86; 1.48-2.34). For the community, top-ranked risk factors in women were menopause (PAF: 63%), obesity (PAF: 29%) and type 2 diabetes (PAF: 15%). Corresponding top-ranked risk factors in men were obesity (PAF: 29%), type 2 diabetes (PAF: 6.4%) and sedentary lifestyle (PAF: 6.0%).Conclusions: Obesity and type 2 diabetes were the most important modifiable chylomicronemia risk factors in women and men, both for the individual and community. This could influence chylomicronemia prevention and help design randomized trials aimed at reducing triglycerides. [ABSTRACT FROM AUTHOR]

Background We aimed to examine separate and joint associations of remnant cholesterol (RC) accumulation and variability with the risk of carotid atherosclerosis (CAS) in the general population. Methods and Results A total of 6213 participants who underwent 3 sequential health examinations during 2010 to 2015 were enrolled and were followed up until December 31, 2021. Cumulative RC (cumRC) and RC variability among the 3 visits were the exposure of interest in our study. Adjusted Cox models were performed to calculate the hazard ratio (HR) and 95% CI. C-statistics, integrated discrimination improvement, and the net reclassification index were used to estimate the incremental predictive ability. During a median follow-up of 4.00 years, 2613 participants developed CAS. Higher cumRC (HR, 1.33 [95% CI, 1.17-1.52]) and greater RC variability (HR, 1.22 [95% CI, 1.08-1.39]) were significantly associated with elevated risk of CAS, independent of traditional cardiovascular risk factors and low-density lipoprotein cholesterol. Participants were divided into 4 groups according to the median of cumRC and RC variability to assess their joint associations. Compared with "low cumRC and low variability," "high cumRC and high variability" had the highest risk of CAS, followed by "high cumRC and low variability" and "low cumRC and high variability." Finally, joint assessment of RC accumulation and variability had the significantly highest incremental effect on the predictive value of CAS versus single-time-point measures of RC. Conclusions Excessive cumRC levels and greater RC variability were each independently associated with higher incidence of CAS, and their coexistence could further yield significantly higher risks.

Background Remnant cholesterol (RC) has been reported to promote atherosclerotic cardiovascular disease. Yet little is known regarding the RC-related residual risk in patients with myocardial infarction (MI) with nonobstructive coronary arteries. Methods and Results A total of 1179 patients with MI with nonobstructive coronary arteries were enrolled and divided according to median level of RC calculated as non-high-density lipoprotein cholesterol minus low-density lipoprotein cholesterol. The primary end point was a composite of major adverse cardiovascular events (MACEs), including all-cause death, nonfatal MI, stroke, revascularization, and hospitalization for unstable angina or heart failure. Kaplan-Meier, Cox regression, and receiver-operating characteristic analyses were used. Patients with higher median level of RC had a significantly higher incidence of MACEs (16.9% versus 11.5%; P =0.009) over the median follow-up of 41.7 months. High RC levels were significantly associated with an increased risk of MACEs after adjustment for multiple clinically relevant variables (per 1 SD increase, hazard ratio, 0.61; 95% CI, 1.12-2.31; P =0.009). Elevated RC also contributed to residual risk beyond conventional lipid parameters. Moreover, RC had an area under the curve of 0.61 for MACE prediction. When adding RC to the Thrombolysis in Myocardial Infarction risk score, the combined model yielded a significant improvement in discrimination for MACEs. Conclusions Elevated RC was closely associated with poor outcomes after MI with nonobstructive coronary arteries independent of traditional risk factors, indicating the utility of RC for risk stratification and a rationale for targeted RC-lowering trials in patients with MI with nonobstructive coronary arteries.