---
title: "Remnant cholesterol predicts incident diabetic retinopathy in type 2 diabetes: prospective cohort"
id: "pubmed-42841658"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42841658"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42841658/"
doi: "10.1080/07853890.2026.2741438"
published_at: "2026-10-07T12:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Remnant cholesterol predicts incident diabetic retinopathy in type 2 diabetes: prospective cohort
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42841658
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42841658/)
- **DOI:** [10.1080/07853890.2026.2741438](https://doi.org/10.1080%2F07853890.2026.2741438)
- **Published At:** 2026-10-07T12:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Background: Patients with **type 2 diabetes (T2D)** retain substantial vascular risk despite guideline-directed LDL-C control; **remnant cholesterol (RC)** is an atherogenic lipid fraction proposed to contribute to residual risk. - Study design: A community-based prospective cohort of 1,580 Chinese adults with T2D without baseline diabetic retinopathy (DR) recruited between 2017 and 2019 and followed annually through 2023. Time-dependent Cox regression was used to assess longitudinal associations. - Outcomes: 304 incident DR cases were observed across five follow-up visits. - Main associations: Per one-unit increase in natural log-transformed RC, adjusted hazard ratio (aHR) for new-onset DR was **1.26** (95% CI 1.08–1.47). RC ≥0.8 mmol/L was associated with a 50% higher DR risk (aHR **1.50**, 95% CI 1.11–2.03). - Robustness: The associations persisted among participants who met guideline-recommended targets for triglycerides, LDL-C, and HDL-C, indicating RC contributed to residual risk even with otherwise optimal conventional lipid profiles. - Effect modification: Associations were more pronounced in women and in patients with longer diabetes duration (p for interaction <0.05). - Implication: Elevated **RC** appears to be an independent predictor of incident **diabetic retinopathy**, suggesting potential value in integrating RC into routine metabolic monitoring for improved DR risk stratification. - Reporting gaps: The abstract does not list the full set of covariates used in adjusted models or specific definitions for DR severity, nor does it provide absolute event rates, duration of follow-up per participant, or detailed methodology for RC measurement beyond the reported thresholds.
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Epub 2026 Oct 7. # Association between remnant cholesterol and incident diabetic retinopathy in patients with type 2 diabetes: a prospective cohort study [Hui Cheng](https://pubmed.ncbi.nlm.nih.gov/?term=Cheng+H&cauthor_id=42841658)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42841658/#full-view-affiliation-1 "School of Public Health, Sun Yat-Sen University, Guangzhou, China."), [Jiaheng Chen](https://pubmed.ncbi.nlm.nih.gov/?term=Chen+J&cauthor_id=42841658)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42841658/#full-view-affiliation-1 "School of Public Health, Sun Yat-Sen University, Guangzhou, China."), [Yu Ting Li](https://pubmed.ncbi.nlm.nih.gov/?term=Li+YT&cauthor_id=42841658)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42841658/#full-view-affiliation-2 "State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42841658/#full-view-affiliation-3 "Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China."), [Tai Weng](https://pubmed.ncbi.nlm.nih.gov/?term=Weng+T&cauthor_id=42841658)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42841658/#full-view-affiliation-1 "School of Public Health, Sun Yat-Sen University, Guangzhou, China."), [Yao Jie Xie](https://pubmed.ncbi.nlm.nih.gov/?term=Xie+YJ&cauthor_id=42841658)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42841658/#full-view-affiliation-4 "School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42841658/#full-view-affiliation-5 "Joint Research Centre for Primary Health Care, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42841658/#full-view-affiliation-6 "Research Centre for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR."), [Jose Hernandez](https://pubmed.ncbi.nlm.nih.gov/?term=Hernandez+J&cauthor_id=42841658)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42841658/#full-view-affiliation-7 "Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg.")[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42841658/#full-view-affiliation-8 "Green Templeton College, University of Oxford, Oxford, UK."), [Wenyong Huang](https://pubmed.ncbi.nlm.nih.gov/?term=Huang+W&cauthor_id=42841658)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42841658/#full-view-affiliation-2 "State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42841658/#full-view-affiliation-3 "Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China."), [Harry H X Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+HHX&cauthor_id=42841658)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42841658/#full-view-affiliation-1 "School of Public Health, Sun Yat-Sen University, Guangzhou, China.")[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42841658/#full-view-affiliation-9 "General Practice Center, The Seventh Affiliated Hospital of Southern Medical University, Foshan, China.")[ 10 ](https://pubmed.ncbi.nlm.nih.gov/42841658/#full-view-affiliation-10 "JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong SAR.") Affiliations Expand ### Affiliations * 1 School of Public Health, Sun Yat-Sen University, Guangzhou, China. * 2 State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China. * 3 Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China. * 4 School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR. * 5 Joint Research Centre for Primary Health Care, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR. * 6 Research Centre for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR. * 7 Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg. * 8 Green Templeton College, University of Oxford, Oxford, UK. * 9 General Practice Center, The Seventh Affiliated Hospital of Southern Medical University, Foshan, China. * 10 JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong SAR. * PMID: **42841658** * DOI: [ 10.1080/07853890.2026.2741438 ](https://doi.org/10.1080/07853890.2026.2741438) Item in Clipboard # Association between remnant cholesterol and incident diabetic retinopathy in patients with type 2 diabetes: a prospective cohort study Hui Cheng et al. Ann Med. 2026 Dec. Show details Display options Display options Format Abstract PubMed PMID Ann Med Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Ann+Med%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Ann+Med%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42841658/) . 2026 Dec;58(1):2741438. doi: 10.1080/07853890.2026.2741438. Epub 2026 Oct 7. ### Authors [Hui Cheng](https://pubmed.ncbi.nlm.nih.gov/?term=Cheng+H&cauthor_id=42841658)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42841658/#short-view-affiliation-1 "School of Public Health, Sun Yat-Sen University, Guangzhou, China."), [Jiaheng Chen](https://pubmed.ncbi.nlm.nih.gov/?term=Chen+J&cauthor_id=42841658)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42841658/#short-view-affiliation-1 "School of Public Health, Sun Yat-Sen University, Guangzhou, China."), [Yu Ting Li](https://pubmed.ncbi.nlm.nih.gov/?term=Li+YT&cauthor_id=42841658)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42841658/#short-view-affiliation-2 "State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42841658/#short-view-affiliation-3 "Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China."), [Tai Weng](https://pubmed.ncbi.nlm.nih.gov/?term=Weng+T&cauthor_id=42841658)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42841658/#short-view-affiliation-1 "School of Public Health, Sun Yat-Sen University, Guangzhou, China."), [Yao Jie Xie](https://pubmed.ncbi.nlm.nih.gov/?term=Xie+YJ&cauthor_id=42841658)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42841658/#short-view-affiliation-4 "School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42841658/#short-view-affiliation-5 "Joint Research Centre for Primary Health Care, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42841658/#short-view-affiliation-6 "Research Centre for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR."), [Jose Hernandez](https://pubmed.ncbi.nlm.nih.gov/?term=Hernandez+J&cauthor_id=42841658)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42841658/#short-view-affiliation-7 "Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg.")[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42841658/#short-view-affiliation-8 "Green Templeton College, University of Oxford, Oxford, UK."), [Wenyong Huang](https://pubmed.ncbi.nlm.nih.gov/?term=Huang+W&cauthor_id=42841658)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42841658/#short-view-affiliation-2 "State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42841658/#short-view-affiliation-3 "Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China."), [Harry H X Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+HHX&cauthor_id=42841658)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42841658/#short-view-affiliation-1 "School of Public Health, Sun Yat-Sen University, Guangzhou, China.")[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42841658/#short-view-affiliation-9 "General Practice Center, The Seventh Affiliated Hospital of Southern Medical University, Foshan, China.")[ 10 ](https://pubmed.ncbi.nlm.nih.gov/42841658/#short-view-affiliation-10 "JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong SAR.") ### Affiliations * 1 School of Public Health, Sun Yat-Sen University, Guangzhou, China. * 2 State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China. * 3 Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China. * 4 School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR. * 5 Joint Research Centre for Primary Health Care, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR. * 6 Research Centre for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR. * 7 Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg. * 8 Green Templeton College, University of Oxford, Oxford, UK. * 9 General Practice Center, The Seventh Affiliated Hospital of Southern Medical University, Foshan, China. * 10 JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong SAR. * PMID: **42841658** * DOI: [ 10.1080/07853890.2026.2741438 ](https://doi.org/10.1080/07853890.2026.2741438) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Background:** Despite optimal low-density lipoprotein cholesterol (LDL-C) management, residual vascular risk remains high in patients with type 2 diabetes (T2D). Remnant cholesterol (RC) is an atherogenic lipid fraction, yet its longitudinal association with diabetic retinopathy (DR) remains insufficiently characterised. We aimed to evaluate whether longitudinal RC measurements independently predict new-onset DR. **Materials and methods:** We recruited 1,580 Chinese adults with T2D and no DR from a community-based prospective cohort established between 2017 and 2019. Participants were followed annually until 2023. Association between RC and incident DR was evaluated using time-dependent Cox regression models. We specifically examined this association among participants who achieved clinical targets for conventional lipid panel. **Results:** We observed 304 incident DR cases during five follow-up visits. Each one-unit increase in natural log-transformed RC was associated with a 26% higher risk of new-onset DR (adjusted hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.08-1.47). Elevated RC (≥0.8 mmol/L) was associated with a 50% increased DR risk (aHR 1.50, 95% CI 1.11-2.03). These associations persisted among participants meeting guideline-recommended targets for triglycerides, LDL-C, and high-density lipoprotein cholesterol. Such associations were more prominent in women and patients with longer duration of T2D (_p_ for interaction <0.05). **Conclusions:** Elevated RC is an independent risk factor for new-onset DR and represents an important contributor to residual risk in patients with otherwise optimal lipid profiles. These findings suggest that RC merits consideration for integration into routine metabolic monitoring to improve DR risk stratification, particularly among female patients and those with long-standing diabetes. **Keywords:** Remnant cholesterol; diabetic retinopathy; longitudinal study; residual risk; type 2 diabetes. 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