Serum remnant cholesterol demonstrates an independent cross-sectional association with cerebral ischemic stroke among hospitalized patients with type 2 diabetes mellitus, according to a research study published in BMC Endocrine Disorders. Ischemic stroke represents a severe macrovascular complication frequently affecting individuals with type 2 diabetes mellitus, and while remnant cholesterol has previously been linked to atherosclerotic cardiovascular events, relevant data focusing specifically on Chinese patients with type 2 diabetes have remained limited. To address this knowledge gap, the study aimed to explore the association between remnant cholesterol levels and cerebral ischemic stroke in this patient population, revealing a significant independent cross-sectional relationship characterized by a distinct nonlinear curve.
The investigation enrolled a total of 521 inpatients diagnosed with type 2 diabetes mellitus to assess how lipid profiles and clinical factors align with cerebrovascular outcomes. The study population was categorized into two distinct comparison groups: a cohort of 309 patients diagnosed with type 2 diabetes alone, and a cohort of 212 patients diagnosed with both type 2 diabetes and cerebral ischemic stroke. The research team collected comprehensive demographic characteristics alongside routine laboratory data for all 521 participants in order to accurately calculate serum remnant cholesterol levels. The investigative protocol employed multiple analytical strategies, including Spearman rank correlation, multivariate logistic regression, and restricted cubic spline modeling.
Baseline clinical and demographic comparisons demonstrated several marked differences between the two participant groups. Inpatients belonging to the group with both type 2 diabetes and cerebral ischemic stroke were older and had lived with diabetes for a longer duration than individuals in the diabetes-only group. In addition, the diabetes with ischemic stroke cohort exhibited a significantly higher clinical prevalence of concurrent vascular and organ complications, including coronary heart disease, lower extremity arteriosclerosis obliterans, and diabetic nephropathy. Each of these baseline clinical differences between the two inpatient groups was statistically significant (all P < 0.05).
Physiological monitoring and circulating lipid panels further differentiated the two study groups. Patients presenting with type 2 diabetes and cerebral ischemic stroke exhibited higher systolic blood pressure and higher serum remnant cholesterol levels, alongside a higher frequency of statin usage. At the same time, this group demonstrated lower levels of low-density lipoprotein cholesterol and lower levels of high-density lipoprotein cholesterol compared to the diabetes-only group, with all of these comparisons reaching statistical significance at P < 0.05. Spearman rank correlation analysis established that remnant cholesterol was positively correlated with triglycerides (r = 0.445, P < 0.001) and total cholesterol (r = 0.356, P < 0.001). Remnant cholesterol was also positively correlated with systolic blood pressure (r = 0.090, P < 0.05), diastolic blood pressure (r = 0.129, P < 0.05), and uric acid (r = 0.119, P < 0.05), while showing a significant negative correlation with low-density lipoprotein cholesterol (r = -0.247, P < 0.001).
Following adjustments for confounding variables, multivariate logistic regression demonstrated that elevated remnant cholesterol remained independently associated with ischemic stroke in patients with type 2 diabetes mellitus. Subgroup analyses indicated that this cross-sectional association between elevated remnant cholesterol and stroke status was substantially more pronounced among older individuals. Specifically, participants aged 65 years or older exhibited an adjusted odds ratio of 501.290 (95% confidence interval: 116.872–2949.301), compared to an odds ratio of 30.283 (95% confidence interval: 12.192–91.289) among participants younger than 65 years. In contrast to the age stratification, the researchers observed no statistically significant interactions when evaluating subgroups stratified by sex, coronary heart disease, arteriosclerosis obliterans, or statin use, as all interaction P values exceeded 0.05.
To evaluate the precise shape of the relationship across continuous exposure levels, the authors applied restricted cubic spline modeling to the dataset. This analysis uncovered a clear nonlinear relationship between serum remnant cholesterol concentrations and the odds of cerebral ischemic stroke. In the lower range of remnant cholesterol measurements, the odds of ischemic stroke increased at a relatively slow pace. Once remnant cholesterol reached approximately 1.07 mmol/L, however, the association changed noticeably, and the odds of cerebral ischemic stroke increased markedly beyond this concentration threshold.
The authors emphasized important limitations and interpretive boundaries concerning the higher exposure levels in their inpatient sample. Because of the limited sample size available for remnant cholesterol levels exceeding 1.96 mmol/L, the calculated confidence intervals were wider and estimation precision was reduced within that upper range. Consequently, the researchers noted that the association trend above 1.96 mmol/L warrants further verification in larger study cohorts. In their conclusion, the authors stated that serum remnant cholesterol exhibits an independent cross-sectional association and a nonlinear relationship with ischemic stroke in type 2 diabetes, with a marked increase occurring above approximately 1.07 mmol/L. These observations highlight remnant cholesterol as a potential residual atherosclerotic risk marker, though prospective studies are necessary to confirm these findings.
Subject of Research: Remnant cholesterol and ischemic stroke in type 2 diabetes
Article Title: Association between remnant cholesterol levels and cerebral ischemic stroke in Chinese patients with type 2 diabetes mellitus
Article References: Shi, P., Wu, Y., Qiu, Y., Li, C., & Lyu, Y. (2026). Association between remnant cholesterol levels and cerebral ischemic stroke in Chinese patients with type 2 diabetes mellitus. BMC Endocrine Disorders. https://doi.org/10.1186/s12902-026-02722-z
Image Credits: AI Generated
DOI: 10.1186/s12902-026-02722-z
Keywords: remnant cholesterol, ischemic stroke, type 2 diabetes, atherosclerosis, lipids, cardiovascular risk, blood pressure, endocrinology, Association, between, remnant, cholesterol
