Non-HDL Cholesterol and Remnant Cholesterol Predict Different Components of the Metabolic Syndrome in Type 2 Diabetes Mellitus Patients in a Regional Hospital

Abstract Type 2 diabetes mellitus (T2DM) continues to increase in incidence within the ageing population of the globe. Patients with T2DM have a 2-4 times higher risk of experiencing an adverse cardiovascular event than their non-diabetic counterparts. Total cholesterol, low-density lipoprotein (LDL), triglycerides and high-density lipoprotein (HDL) cholesterol levels have been the routine biomarkers for lipid-based cardiovascular disease diagnostic and prognostic decisions in clinical practice. Recent evidence elsewhere suggests remnant cholesterol (RC) and Non-HDL cholesterol (Non-HDL-c) can serve as biomarkers with a higher predictive power for cardiovascular disease (CVD) than the aforementioned routine ones. In our context, there is limited information on the suitability and superiority of these emerging biomarkers for the assessment of CVD risk in T2DM. The current study therefore sought to examine the relationship between RC and non-HDL-c for predicting CVD in T2DM patients in the context of the obesity paradox. Apart from adiponectin level which was lower (P < 0.05), overweight/obese respondents exhibited higher (P < 0.05) mean levels for all the measured indices. Insulin resistance was independently predicted (R 2 = 0.951; adjusted R 2 = 0.951; P < 0.001) by RC, duration and fasting plasma glucose. However, Non-HDL-c predicted CVD risk (AOR = 4.31; P <0.001), hypertension (AOR = 2.24; P <0.001), resistin (AOR = 2.14; P <0.001) and adiponectin (AOR = -2.24; P <0.001) levels. Our findings point to different mechanisms by which RC and non-HDL-c contribute to the development of CVD.