Title of project

Remnant cholesterol and residual risk of atherosclerotic cardiovascular disease in statin treated individuals with type 2 diabetes

Abstract

Aim: The overall aim of this project is to assess the role of elevated remnant cholesterol on residual risk of atherosclerotic cardiovascular disease (ASCVD) in statin treated individuals with type 2 diabetes (T2D).

Background: Cardiovascular disease is the leading cause of mortality among individuals with T2D, and ASCVD accounts for most cases. Atherosclerosis can be prevented by lowering an individual’s low-density lipoprotein (LDL) cholesterol with statin treatment. But individuals with T2D, continue to develop ASCVD despite this treatment. Elevated remnant cholesterol, which is more prevalent in individuals with T2D than the general population, may be a significant contributor to this residual risk. Currently we lack clear knowledge on how remnant cholesterol and the variability of remnant cholesterol is associated with ASCVD in statin treated individuals with T2D.

Methods: Our primary study will be a prospective, nationwide, observational study, using data from the national Danish health registers. To address the limitations of the national register data we will conduct parallel analyses in a thoroughly phenotyped cohort, the Copenhagen General Population Study (approximately 150,000 individuals). The parallel analyses provide robustness since adjustment for important confounders, such as smoking, alcohol and obesity etc., not available in the national Danish health registers, is possible.Perspectives: The proposed project offers a unique opportunity to explore the role of elevated remnant cholesterol on risk of ASCVD among statin treated individuals with T2D. This is highly relevant as elevated remnant cholesterol is particularly prevalent among individuals with T2D, who pose enormous current and future cardiovascular health burdens. Our project bears clinical relevance, as elevated remnant cholesterol currently emerges as a prospective drug target for primary and secondary prevention and may prove beneficial for better prediction of cardiovascular risk. Hence, randomized clinical trials are currently focusing on remnant cholesterol. Finally, remnant cholesterol has recently gained attention in international guidelines, so our project is timely, as it could contribute to both informing those who plan clinical trials and the development of guidelines.