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The impact of the cumulative burden of LDL-c and hs-CRP on cardiovascular risk: a prospective, population-based study
Jinglin Mo1,2, Zimo Chen1,2, Jie Xu1,2
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Insights
Cumulative burden of high-sensitivity C-reactive protein (cumhs-CRP) increases cardiovascular risk, especially in those with low low-density lipoprotein-cholesterol (cumLDL-c). This highlights residual inflammation risk in managing cardiovascular events.
Area of Science:
- Cardiovascular disease research
- Biomarker analysis
- Epidemiology
Background:
- Cardiovascular risk assessment often relies on single time-point measurements.
- The cumulative impact of biomarkers like LDL-c and hs-CRP on cardiovascular risk is not fully understood.
- Residual inflammation may contribute to cardiovascular events even with controlled LDL-c levels.
Purpose of the Study:
- To investigate the impact of cumulative low-density lipoprotein-cholesterol (cumLDL-c) and cumulative high-sensitivity C-reactive protein (cumhs-CRP) on major adverse cardiac events (MACE).
- To evaluate the association between cumhs-CRP and MACE in individuals with low cumLDL-c.
- To validate the role of residual inflammation in cardiovascular risk.
Main Methods:
- Prospective, population-based Kailuan study with 36,421 participants.
- Biennial measurements of hs-CRP and LDL-c from 2006-2013.
- Calculation of cumhs-CRP and cumLDL-c based on biennial measurements and follow-up for MACE (2012-2017).
Main Results:
- Both cumLDL-c and cumhs-CRP were identified as independent risk factors for MACE.
- Participants with cumhs-CRP exhibited a higher risk of MACE in the subsequent 5 years compared to those without, even without elevated cumLDL-c.
- A dose-dependent relationship was observed between cumhs-CRP levels and MACE risk.
Conclusions:
- The cumulative burden of hs-CRP is a significant predictor of cardiovascular risk, particularly in individuals with low LDL-c.
- This study underscores the importance of considering long-term biomarker burdens over single measurements for a comprehensive cardiovascular risk assessment.
- Residual inflammation, as indicated by hs-CRP, plays a crucial role in cardiovascular event risk.
Background:
This study aims to demonstrate the impact of the cumulative burden of low density lipoprotein-cholesterol (cumLDL-c) and high sensitivity C-reactive protein (cumhs-CRP) on cardiovascular risk.
Results:
During the 4.62 (±0.70) years of follow-up, 2,148 (5.92%) participants had MACE. Both of cumLDL-c and cumhs-CRP were independent risk factors for MACE. In participants without cumLDL-c during 2006-2013, the participants with cumhs-CRP had higher MACE risk during the subsequent 5 years, than those without cumhs-CRP (hazard ratio [HR]: 1.24, 95% confidence interval [CI]:1.04-1.47). In addition, cumhs-CRP correlated with MACE in a cumhs-CRP level-dependent pattern.
Conclusion:
This study validated the effects of residual inflammation risk in patients with low LDL-c Level in a general population, using long-term burdens of hs-CRP or LDL-c other than a single time-point level.
Method:
The Kailuan study is a prospective, population-based study began in 2006. These total 36,421 participants completed 4 measurements of hs-CRP and LDL-c biennially from 2006-2013. Cumhs-CRP or cumLDL-c levels were calculated as the number of interval years multiplied by the Δhs-CRP (more than 2.0 mg/L) or ΔLDL-c (more than 2.6 mmol/L). Outcomes measured during follow-up (2012-2017) were defined as major adverse cardiac events (MACE), including ischemic stroke, myocardial infarction, and all-cause mortality.
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