What is the clinical evidence from this study?

Study design: Observational. Population: acute myocardial infarction (n=520). Primary outcome: major adverse cardiovascular events (MACE) (HR 1.89, 95% CI 1.29-2.78, p=<0.001).

What does this research mean for the field?

The combined presence of elevated remnant cholesterol and diabetes mellitus synergistically increases the risk of major adverse cardiovascular events by 89% in patients with acute myocardial infarction compared to having only one of these risk factors. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The research aims to clarify how remnant cholesterol and diabetes mellitus together affect the prognosis of acute myocardial infarction.

March 17, 2026European journal of medical research0 citationsOpen Access

The interaction between remnant cholesterol and diabetes mellitus on the prognosis of acute myocardial infarction

Q: What are the key findings of this study?

The presence of both elevated remnant cholesterol and diabetes mellitus increased the risk of major adverse cardiovascular events by 89% in acute myocardial infarction patients compared to those with only one of these risk factors.

Q: What does this research mean for the field?

The combined presence of elevated remnant cholesterol and diabetes mellitus synergistically increases the risk of major adverse cardiovascular events by 89% in patients with acute myocardial infarction compared to having only one of these risk factors. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

The research aims to clarify how remnant cholesterol and diabetes mellitus together affect the prognosis of acute myocardial infarction.

YYYu YangAnhui Medical University JWJia‐Yi WangZhejiang International Studies University JZJian ZhangAnhui Medical University

Key Result

The presence of both elevated remnant cholesterol and diabetes mellitus increased the risk of major adverse cardiovascular events by 89% in acute myocardial infarction patients compared to those with only one of these risk factors.

Key Points

The research aims to clarify how remnant cholesterol and diabetes mellitus together affect the prognosis of acute myocardial infarction.
Retrospective study of 520 acute myocardial infarction patients
Assessment of major adverse cardiovascular events (MACE) and cardiac mortality
Evaluated interactions using Cox regression and Kaplan–Meier survival analysis
ROC analysis conducted to estimate predictive ability of remnant cholesterol in diabetic patients
120 major adverse cardiovascular events (23.08%) and 35 cardiac mortalities (6.73%) over 45 months follow-up observed
62% of MACE risk attributed to interaction between high remnant cholesterol and diabetes
Synergy index of 3.46 suggests combined risk exceeds individual risks
Higher area under the curve (AUC) for remnant cholesterol in estimating MACEs among diabetes patients, reaching 0.676

Study Design

Type

Observational (n=520)

Multicenter

Structured PICO

Does the combination of elevated remnant cholesterol and diabetes mellitus synergistically increase the risk of major adverse cardiovascular events in patients with acute myocardial infarction?

Population

520 patients with acute myocardial infarction (AMI), median age 65 years, 351 males. Excluded: acute or chronic persistent infection, malignant tumors, severe cerebrovascular accidents, severe hepatic or renal insufficiency, severe primary valvular heart disease, and non-ischemic cardiomyopathy.

Intervention

Elevated remnant cholesterol (>0.79 mmol/L) combined with diabetes mellitus

Comparator

Low remnant cholesterol (≤0.79 mmol/L) and/or absence of diabetes mellitus

Outcome

Major adverse cardiovascular events (MACE), a composite of death (cardiac and non-cardiac), revascularization procedures, recurrent MI, and hospital readmission owing to angina or heart failurecomposite

Elevated remnant cholesterol and diabetes mellitus exert a synergistic adverse effect on the prognosis of patients with acute myocardial infarction, highlighting the need for comprehensive management of atherogenic dyslipidemia and dysglycemia.

Main Result

Effect estimate: HR 1.89 (95% CI 1.29-2.78)

p-value: p=<0.001

Limitations

Retrospective, single-center design limits generalizability and statistical power.
Relatively low MACE rate may affect the stability of multivariable models.
RC was measured only at baseline, lacking dynamic assessment.

Abstract

The prognostic relevance of Remnant cholesterol (RC) in acute myocardial infarction (AMI), particularly in diabetes mellitus (DM) patients, remains unclarified. This research aimed to explore the interaction between elevated RC and DM on the prognosis of AMI, with the goal of improving risk stratification and guiding intervention strategies. In this retrospective, single-center study, 520 AMI patients were recruited. Basic and follow-up information was acquired, with the primary endpoint being major adverse cardiovascular events (MACE) and the secondary endpoint being cardiac mortality. Multiplicative and additive interactions were assessed to determine the combined impact of RC and DM on prognosis. Analytical methods included Cox regression, Kaplan–Meier survival, and ROC analyses. Over a median follow-up of 45 (42–49) months, 120 (23.08%) MACEs and 35 (6.73%) cardiac mortalities were observed. An additive interaction between elevated RC and DM was positively related to MACEs, with the attributable proportion suggesting that 62% of MACE risk could be attributed to this interaction. The synergy index was 3.46 for MACE, suggesting that the combined risk of both factors exceeded the sum of their individual risks. Multivariate Cox regression analysis identified RC as a significant predictor of both MACEs and cardiac death. Kaplan–Meier survival curves indicated an obvious increase in MACE when both high RC and DM were present (log-rank test, P < 0.001). ROC analysis demonstrated that AUC for RC in estimating MACEs was higher in DM patients, reaching 0.676 (95% CI 0.567–0.786). The combined presence of elevated RC and DM exerts a synergistic effect, providing valuable insights for the risk stratification of AMI patients.

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