Association between remnant cholesterol levels and cerebral ischemic stroke in Chinese patients with type 2 diabetes mellitus

Q: What are the key findings of this study?

Elevated serum remnant cholesterol (>1.07 mmol/L) was independently associated with ischemic stroke in Chinese patients with T2DM (adjusted OR 24.109, 95% CI 14.058-41.344, P<0.001).

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Type 2 diabetes mellitus (n=521). Intervention: Elevated serum remnant cholesterol (>1.07 mmol/L) vs. Low serum remnant cholesterol (≤1.07 mmol/L). Primary outcome: Ischemic stroke status in patients with type 2 diabetes mellitus (OR 24.109, 95% CI 14.058-41.344, p=<0.001).

Q: What does this research mean for the field?

Elevated serum remnant cholesterol levels are independently and nonlinearly associated with increased odds of ischemic stroke in patients with type 2 diabetes mellitus, with risk increasing markedly above 1.07 mmol/L. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Pingan Shi; Yu Wu; Yaxin Qiu; 李常品; Yuanjun Lyu

doi:10.1186/s12902-026-02722-z

November 9, 2026BMC Endocrine DisordersOpen Access

Association between remnant cholesterol levels and cerebral ischemic stroke in Chinese patients with type 2 diabetes mellitus

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Key result

Elevated remnant cholesterol linked to ~24.1-fold higher odds of ischemic stroke in T2DM.

OR 24.109
95% CI 14.058-41.344
P<0.001
n=521

Why the study?

Remnant cholesterol has been linked to atherosclerotic cardiovascular events, but data on its association with ischemic stroke in Chinese patients with T2DM remain limited.

Is elevated serum remnant cholesterol (>1.07 mmol/L) associated with cerebral ischemic stroke in hospitalized Chinese patients with type 2 diabetes mellitus?

Key Points

To investigate the association between serum remnant cholesterol (RC) levels and cerebral ischemic stroke (IS) in Chinese patients with type 2 diabetes mellitus (T2DM).
Enrolled 521 hospitalized patients with T2DM, divided into a T2DM-only group (n = 309) and a T2DM with IS group (n = 212).
Calculated RC from laboratory lipid profiles and evaluated associations using Spearman rank correlation, multivariable logistic regression, receiver operating characteristic (ROC) curves, and restricted cubic spline (RCS) analyses.
Median RC was significantly higher in the IS group compared to the non-IS group (1.62 mmol/L vs. 0.78 mmol/L, P < 0.001), with an optimal discriminative cut-off of 1.07 mmol/L (AUC = 0.87, 95% CI: 0.84–0.90).
Elevated RC (> 1.07 mmol/L) showed an independent cross-sectional association with IS in fully adjusted Model 3 (OR = 24.109, 95% CI: 14.058–41.344, P < 0.001), which was stronger in patients aged ≥ 65 years (OR = 501.290, 95% CI: 116.872–2949.301) than those aged < 65 years (OR = 30.283, 95% CI: 12.192–91.289).
RCS modeling demonstrated a nonlinear dose-response relationship where IS odds increased slowly at lower RC concentrations and escalated markedly once RC reached approximately 1.07 mmol/L.

Study Design

Type

Cross-Sectional (n=521)

Multicenter

No

Structured PICO

Is elevated serum remnant cholesterol (>1.07 mmol/L) associated with cerebral ischemic stroke in hospitalized Chinese patients with type 2 diabetes mellitus?

P

Population

521 Chinese inpatients with type 2 diabetes mellitus (median age 66 years, 48.94% female), including 212 with confirmed prior atherosclerotic ischemic stroke and 309 without ischemic stroke.

E

Exposure

Elevated serum remnant cholesterol (RC > 1.07 mmol/L, calculated as TC - HDL-C - LDL-C from fasting morning blood samples)

C

Comparator

Low serum remnant cholesterol (RC ≤ 1.07 mmol/L)

O

Outcome

Presence of cerebral ischemic stroke (IS), diagnosed via acute focal/global neurological deficits and brain CT/MRI showing an infarct lesion >1.5 cm with >50% cerebral artery stenosis/vulnerable plaque on angiography, or isolated perforating artery territory infarct with feeding artery ostium occlusion on high-resolution MRIhard clinical

Main Result

Odds Ratio: 24.109 (95% CI 14.058–41.344)

Absolute Event Rate: 70.43% vs 11.74%

p-value: p=<0.001

Serum remnant cholesterol exhibits a strong, nonlinear cross-sectional association with cerebral ischemic stroke in Chinese patients with type 2 diabetes mellitus, particularly when levels exceed 1.07 mmol/L, highlighting its potential utility as a residual atherosclerotic risk marker.

Limitations

Single-center retrospective cross-sectional study design precludes causal inference
Lipid parameters were measured after the index ischemic stroke event rather than pre-stroke
Limited sample size for remnant cholesterol levels >1.96 mmol/L resulted in wider confidence intervals and reduced estimation precision
High disease prevalence in the study sample causes the odds ratio to overestimate the prevalence ratio
Single-center retrospective cross-sectional study design requiring prospective validation
Limited sample size for remnant cholesterol levels > 1.96 mmol/L, resulting in wider confidence intervals and reduced estimation precision in that range
High prevalence of the outcome leads to odds ratios overestimating the prevalence ratio
Laboratory tests including lipid parameter measurements were performed after the index ischemic stroke event

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Implication

May support remnant cholesterol as residual stroke risk marker in T2DM; leaves open prospective validation before clinical adoption.

Abstract

Background Ischemic stroke (IS) is a severe macrovascular complication in patients with type 2 diabetes mellitus (T2DM). Remnant cholesterol (RC) has been linked to atherosclerotic cardiovascular events; however, relevant data focusing on Chinese patients with T2DM remain limited. This study aimed to explore the association between RC and IS in patients with T2DM. Methods A total of 521 inpatients with T2DM were enrolled and divided into T2DM-only ( n = 309) and T2DM with IS ( n = 212) groups. Demographic characteristics and laboratory data were collected to calculate RC levels. Statistical analyses included Spearman rank correlation, multivariate logistic regression, and restricted cubic spline (RCS) modeling. Results Compared with the T2DM-only group, the T2DM with IS group was older, had a longer diabetes duration, and exhibited higher prevalence of coronary heart disease (CHD), lower extremity arteriosclerosis obliterans, and diabetic nephropathy. Additionally, this group exhibited higher systolic blood pressure (SBP) and RC levels, higher statin usage, and lower low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) levels (all P < 0.05). RC was positively correlated with triglycerides (TG, r = 0.445), total cholesterol (TC, r = 0.356), systolic blood pressure (SBP, r = 0.090), diastolic blood pressure (DBP, r = 0.129), and uric acid (UA, r = 0.119), but negatively correlated with LDL-C ( r =-0.247) ( P < 0.05 for SBP, DBP and UA, P < 0.001 for others). Elevated RC showed an independent cross-sectional association with T2DM with IS (multivariate-adjusted). Subgroup analyses revealed that this cross-sectional association between elevated RC and IS status was more pronounced in participants aged ≥ 65 years than in those aged < 65 years (OR = 501.290, 95%CI: 116.872–2949.301 vs. OR = 30.283, 95%CI: 12.192–91.289). In contrast, no significant interactions were observed for subgroups stratified by sex, CHD, ASO or statin use (all P values for interactions > 0.05). RCS analysis revealed a nonlinear relationship between RC and the odds of IS: the odds increased relatively slowly at lower RC levels, and increased markedly when RC reached approximately 1.07 mmol/L. However, due to the limited sample size for RC level > 1.96 mmol/L, confidence intervals were wider and estimation precision was reduced; thus, the association trend within this range warrants further verification in larger study cohorts. Conclusion Serum RC shows a cross-sectional association with IS in patients with T2DM, and there is a nonlinear relationship between them, with a marked increase in association when RC exceeds approximately 1.07 mmol/L. Our findings highlight the potential clinical relevance of RC as a residual atherosclerotic risk marker among T2DM patients, although prospective studies are needed to validate these observations. Clinical trial number Not applicable.

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Cite This Study

Shi et al. (2026) conducted a cross-sectional in Type 2 diabetes mellitus (n=521). Elevated serum remnant cholesterol (>1.07 mmol/L) vs. Low serum remnant cholesterol (≤1.07 mmol/L) was evaluated on Ischemic stroke status in patients with type 2 diabetes mellitus (OR 24.109, 95% CI 14.058-41.344, p=<0.001). Elevated serum remnant cholesterol (>1.07 mmol/L) was independently associated with ischemic stroke in Chinese patients with T2DM (adjusted OR 24.109, 95% CI 14.058-41.344, P<0.001).

synapsesocial.com/papers/6af3463ebdf2424ebd04f848 https://doi.org/10.1186/s12902-026-02722-z

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Association between remnant cholesterol levels and cerebral ischemic stroke in Chinese patients with type 2 diabetes mellitus

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Association between remnant cholesterol levels and cerebral ischemic stroke in Chinese patients with type 2 diabetes mellitus

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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