Association of remnant cholesterol with progression and regression of prediabetes in middle-aged and older adults: a nationwide cohort study

The relationship between remnant cholesterol (RC) and outcome of patients with prediabetes remains unclear. This study aims to explore the association between dynamic changes in RC and progression to diabetes or regression to normal blood glucose in pre-diabetic population through a nationwide cohort study.

Based on the China Health and Retirement Longitudinal Study (CHARLS), 2304 participants aged 45 years or older (58.60 ± 8.04 years) who participated in two surveys in 2011 and 2015 were included. Participants were divided into 3 groups according to the tertiles of dynamic changes in RC levels between the two surveys (Q1: ≤ – 1.59, Q2: – 1.59–12.73, Q3: ≥ 12.73, mmol/L). Multivariate Logistic regression models were used to analyze the association of the dynamic changes in RC and the progression and regression of prediabetes. Restricted cubic splines were used to analyze the dose-response relationship between RC and dynamic changes in RC and progression in the prediabetic population.

During follow-up, 522 (22.30%) participants developed diabetes, 1283 (54.8%) participants remained prediabetic, and 536 (22.9%) participants regressed to normoglycemia. Further analysis of dynamic changes in RC revealed that reducing RC levels during follow-up reduced the risk of developing diabetes (OR = 0.76, 95% CI: 0.58–0.99, P = 0.04). However, compared with people with increased RC levels, people with prediabetes and stable RC levels are more likely to return to normal blood glucose (OR = 1.45,95% CI: 1.12–1.88, P = 0.005). In the pre-diabetic population, there was non-linear dose-response relationship between the level of RC and dynamic change in RC and the risk of developing diabetes (P nonlinearity < 0.001).

Our findings revealed a substantial and non-linear association between dynamic change in RC levels and the outcome of prediabetes. Decreased RC level were associated with reduced risk of progression to diabetes in prediabetes.