Remnant cholesterol and the risk of incident type 2 diabetes: A community-based 14-year prospective cohort study

초록

BACKGROUND Remnant cholesterol, a marker of triglyceride-rich lipoproteins, has been implicated in cardiometabolic risk; however, its role in predicting incident type 2 diabetes remains incompletely defined, particularly in comparison with conventional lipid parameters. AIM To investigate the association between remnant cholesterol and incident type 2 diabetes and its predictive performance in a community-based cohort. METHODS This prospective study included 7702 Korean adults without diabetes at baseline, who were followed for up to 14 years. Incident diabetes was ascertained using repeated oral glucose tolerance tests in addition to fasting plasma glucose, glycosylated hemoglobin, and medical history. RESULTS During follow-up, 22.0% (1694/7702) of participants developed incident diabetes. In multivariable Cox proportional hazards models, higher remnant cholesterol levels were independently associated with an increased risk of diabetes after adjustment for established risk factors (hazard ratio per 1-SD increase = 1.25; 95%CI: 1.20-1.30). This association was consistently observed across subgroups defined by age, sex, body mass index, metabolic syndrome status, and baseline glycemic status, and appeared more evident in metabolically healthier individuals. Overall, the predictive performance of remnant cholesterol was comparable to that of triglycerides and superior to that of total and low density lipoprotein cholesterol. Notably, remnant cholesterol provided incremental risk reclassification value over non-high density lipoprotein cholesterol among individuals with triglyceride levels < 400 mg/dL. CONCLUSION These findings suggest that remnant cholesterol may serve as a complementary marker for refining diabetes risk stratification, particularly in individuals with relatively low baseline metabolic risk.

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