Associations between very low concentrations of low density lipoprotein cholesterol, high sensitivity C-reactive...

Area of Science:

• Cardiovascular Disease Research
• Inflammation and Atherosclerosis
• Biomarkers of Cardiovascular Risk

Background:

• Inflammation plays a significant role in cardiovascular disease (CVD) risk, even with managed low-density lipoprotein cholesterol (LDL-C).
• Understanding the interplay between LDL-C, high-sensitivity C-reactive protein (hs-CRP), and clinical outcomes is crucial for risk stratification.

Purpose of the Study:

• To investigate the associations between LDL-C levels, hs-CRP levels, and clinical outcomes in a high-risk US population.
• To determine if low LDL-C offers additional cardiovascular protection in the presence of inflammation.

Main Methods:

• Utilized data from the REasons for Geographical And Racial Differences in Stroke (REGARDS) study.
• Included 6136 high-risk participants (Framingham Coronary Risk Score ≥10% or ASCVD risk ≥7.5%).
• Employed Cox proportional hazards models and multiple imputation with chained equations (MICE) to analyze outcomes including all-cause mortality, incident coronary heart disease (CHD), and incident stroke.

Main Results:

• Low hs-CRP (<2 mg/L) was associated with a reduced risk of incident stroke, incident CHD, and CHD death in high-LDL-C individuals.
• Low LDL-C (<70 mg/dL) did not provide additional risk reduction for any outcome in the presence of high hs-CRP.
• High hs-CRP with low LDL-C was linked to a significant increase in all-cause mortality.

Conclusions:

• Low hs-CRP levels are associated with better cardiovascular outcomes in high-risk individuals.
• Inflammatory markers (hs-CRP) may be more critical than LDL-C levels for predicting cardiovascular events in certain high-risk populations.
• Findings underscore the importance of inflammatory pathways in CVD pathogenesis.