Relationship between remnant cholesterol and risk of heart failure in participants with diabetes mellitus: Reply

The Authors Reply: We appreciate the comments on our paper.1 Previous studies showed that patients with diabetes mellitus (DM) had more than two-fold higher risk of developing heart failure (HF) than patients without DM.2,3 Moreover, there was evidence displaying that the occurrence of HF in participants with DM increased their mortality risk by 10-fold, with the 5-year survival rate being only 12.5%.4 Thus, our study targeted patients with DM to evaluate the relationship between remnant cholesterol (RC) and risk of HF. However, we agreed with their comments on participants with acute coronary syndrome and future endeavors to specify diabetes patients with and without coronary heart disease would be worthwhile. Regarding the concern about competing events of mortality, we indeed performed a sensitivity analysis by using a competing risk model and taking all-cause deaths as the competing events of HF.1 The death rates for the low, moderate, and high RC groups were 13.4%, 12.1%, and 12.6%, respectively. Results were largely similar to findings from our main analysis, as shown in Table 4 in our paper. These results further supported robustness of our findings and conclusions. Conflict of interest: None declared.