The Role of Remnant Cholesterol Beyond Low-Density Lipoprotein Cholesterol in Left Ventricular Hypertrophy among Patients with Diabetes

Aims: This study aims to investigate remnant cholesterol (RC), its discordance/concordance with low-density lipoprotein cholesterol (LDL-C), and its interaction with high-sensitivity C-reactive protein (hs-CRP) for left ventricular hypertrophy (LVH) risk in type 2 diabetes mellitus (T2DM). Methods: This cross-sectional study analyzed 30 865 T2DM patients from Tongji Hospital. RC was calculated as total cholesterol minus LDL-C and high-density lipoprotein cholesterol. Multivariable logistic regression and three discordance analyses (cut-off grouping, percentile distance, and residual regression) were used to evaluate the associations of RC and LDL-C with LVH. The interaction between RC and hs-CRP was assessed using clinical cut-offs and the residual cholesterol inflammation index (RCII). Subgroup and sensitivity analyses were employed to verify the results. Results: Elevated LVH risk was associated with the highest quartile (Q4) of RC (odds ratio [OR] = 1.02, 95% confidence interval [CI] 0.99–1.05) compared to Q4 of LDL-C (OR = 1.02, 95% CI 0.99–1.05). Discordance analyses confirmed that high RC, but not high LDL-C, was consistently associated with LVH, notably in the residual model (OR for RC residual = 1.07, 95% CI 1.04–1.10 vs. OR for LDL-C residual = 1.02, 95% CI 0.99–1.05). A synergistic effect on LVH was observed between hs-CRP and RC, with ORs of 1.60 (95% CI 1.45–1.76) in the high RC/hs-CRP group and 1.41 (95% CI 1.30–1.53) in the RCII Q4 group. Results were robust in subgroup and sensitivity analyses. Conclusions: The association of RC with LVH risk in T2DM goes beyond LDL-C and is synergistically enhanced by hs-CRP.