Elevated remnant cholesterol contributes significantly to CVD risk in adults with type 1 diabetes mellitus (T1DM), even after accounting for traditional lipid markers, according to findings published in Endocrine, Diabetes & Metabolism.

In this nested case–control study of 2,187 adults with T1DM, 88 individuals who experienced a first CVD event between 2010 and 2024 were matched 1:1 to controls by age, sex, diabetes duration, HbA1c, smoking status, hypertension, and retinopathy. Remnant cholesterol was calculated as total cholesterol minus HDL-C and LDL-C.

Participants in the highest quartile of remnant cholesterol (>28 mg/dL) had a 4.5-fold greater odds of developing CVD (OR 4.50; 95% CI 1.34–15.08; p = 0.015). The association was evident only in those with LDL-C ≥ 100 mg/dL, while no significant relationship was observed among individuals with LDL-C < 100 mg/dL. A linear trend across LDL-C strata supported a dose–response relationship. Additionally, HDL-C < 45 mg/dL and triglycerides in the highest quartile were associated with greater risk.

Notably, most participants did not meet LDL-C targets, and 41.4% were untreated for dyslipidemia. These results highlight the need for comprehensive lipid assessment and targeted lipid-lowering strategies in T1DM. Incorporating remnant cholesterol into cardiovascular risk evaluation may help address residual risk more effectively.