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. 2025 Jun 30:12:1551203.
doi: 10.3389/fcvm.2025.1551203. eCollection 2025.

Non-high-density lipoprotein cholesterol predicts cardiovascular risk better than remnant cholesterol in patients with type 2 diabetes mellitus

Paul Nsiah  1 , Samuel Acquah  2 , Ansumana Sandy Bockarie  3 , George Adjei  4 , Ebenezer Aniakwaa-Bonsu  5 , Oksana Ryabinina  1
Affiliations

Non-high-density lipoprotein cholesterol predicts cardiovascular risk better than remnant cholesterol in patients with type 2 diabetes mellitus

Paul Nsiah et al. Front Cardiovasc Med. .

Abstract

Background: Cardiovascular disease (CVD) is a leading cause of morbidity in patients with type 2 diabetes mellitus (T2DM). Non-high-density lipoprotein cholesterol (non-HDL-c) and remnant cholesterol (RC) have emerged as promising markers of atherogenic risk, but their comparative predictive performance remains uncertain, particularly in resource-limited settings.

Objective: This study evaluated the predictive value of non-HDL-c and RC for atherosclerotic cardiovascular disease (ASCVD) risk and associated inflammatory and metabolic disturbances in T2DM patients.

Methods: A cross-sectional study was conducted among 154 T2DM patients attending the outpatient diabetic clinic at the Effia Nkwanta Regional Hospital, Ghana. Non-HDL-c and RC were calculated from fasting lipid profiles. The TyG index was used as a surrogate for insulin resistance. ASCVD risk was assessed using the Framingham risk score. Logistic regression and ROC analysis were performed to assess predictive utility. Subgroup analyses were conducted based on BMI, hypertension, and TyG index.

Results: Non-HDL-C was significantly associated with higher ASCVD risk and elevated hs-CRP and resistin levels, while RC showed weaker, non-significant associations. Non-HDL-c had a higher AUC (0.78 vs. 0.62), sensitivity, and specificity. Nearly half of participants (49.4%) had elevated TyG index (>8.7). Non-HDL-C consistently outperformed RC across subgroups.

Conclusion: Non-HDL-c is a stronger and more practical predictor of ASCVD risk than RC in T2DM patients, particularly in settings with limited access to advanced lipid testing. Its use alongside the TyG index offers a cost-effective approach for enhancing cardiovascular risk stratification in diabetes care.

Keywords: atherogenic dyslipidemia; cardiovascular risk; insulin resistance; metabolic syndrome; non-high-density lipoprotein cholesterol; predictive biomarkers; remnant cholesterol; type 2 diabetes mellitus.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Bar chart with error bars of ASCVD risk associated with Non-HDL cholesterol and remnant cholesterol (RC).
Figure 2
Figure 2
ROC curves comparing predictive ability of Non-HDL cholesterol and remnant cholesterol for ASCVD risk. Receiver operating characteristic (ROC) curves illustrate the comparative predictive performance of non-HDL-c (blue curve) and remnant cholesterol (red curve) for ASCVD risk in the study cohort. The AUC for non-HDL-c was 0.81, indicating strong predictive accuracy, whereas RC showed an AUC of 0.66.
See this image and copyright information in PMC

References

    1. Roman G, Stoian AP. Risk/Disease in Type 2 Diabetes MellituCardiovascular s. Type 2 Diabetes - From Pathophysiology to Cyber Systems [Internet]. (2021). Available at: https://www.undefined/state.item.id (Accessed June 27, 2022)
    1. Mensah GA, Wei GS, Sorlie PD, Fine LJ, Rosenberg Y, Kaufmann PG, et al. Decline in cardiovascular mortality: possible causes and implications. Circ Res. (2017) 120(2):366. 10.1161/CIRCRESAHA.116.309115 - DOI - PMC - PubMed
    1. Hedayatnia M, Asadi Z, Zare-Feyzabadi R, Yaghooti-Khorasani M, Ghazizadeh H, Ghaffarian-Zirak R, et al. Dyslipidemia and cardiovascular disease risk among the MASHAD study population. Lipids Health Dis. (2020) 19(1):1–11. 10.1186/s12944-020-01204-y - DOI - PMC - PubMed
    1. Bonilha I, Hajduch E, Luchiari B, Nadruz W, le Goff W, Sposito AC. The reciprocal relationship between LDL metabolism and type 2 diabetes mellitus. Metabolites. (2021) 11(12):807. 10.3390/metabo11120807 - DOI - PMC - PubMed
    1. Wadhera RK, Steen DL, Khan I, Giugliano RP, Foody JM. A review of low-density lipoprotein cholesterol, treatment strategies, and its impact on cardiovascular disease morbidity and mortality. J Clin Lipidol. (2016) 10(3):472–89. 10.1016/j.jacl.2015.11.010 - DOI - PubMed

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