Remnant cholesterol (RC) has been proposed as a contributor to residual cardiovascular risk, yet its role across different glycemic states remains uncertain. A cohort analysis published in Diabetes Research and Clinical Practice evaluated the relationship between baseline RC levels and incident stroke in adults aged 45 years or older without prior stroke.

The study used data from the China Health and Retirement Longitudinal Study. Baseline RC was categorized into quartiles, and incident self-reported stroke over 7 years was the primary outcome. Associations were examined using Kaplan–Meier curves, Cox proportional hazards models, and restricted cubic spline analyses. Stratified analyses were performed by glucose metabolism status, including normal glucose regulation (NGR), prediabetes (Pre-DM), and diabetes mellitus (DM), and by the clinical low-density lipoprotein cholesterol (LDL-C) threshold of 130 mg/dL.

During follow-up, 867 participants (9.44%) developed stroke. Stroke risk increased across RC quartiles in the overall cohort and among participants with Pre-DM and DM, but not in those with NGR. In fully adjusted models, compared with the lowest RC quartile, hazard ratios (95% CIs) for stroke were 1.228 (0.980-1.537), 1.390 (1.116-1.730), and 1.419 (1.138-1.769) for quartiles 2, 3, and 4, respectively.

Stratified analyses demonstrated significant associations in Pre-DM and DM, particularly among individuals with LDL-C levels <130 mg/dL. No association between RC and stroke was observed in those with NGR.

These findings indicate that higher RC levels were independently associated with incident stroke among individuals with Pre-DM and DM, especially when LDL-C was below 130 mg/dL. These results suggest potential value for RC assessment beyond  LDL-C thresholds in these populations.