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Remnant cholesterol as a risk factor for cardiovascular, cancer or other causes mortality: A competing risks analysis

Caterina Bonfiglio1, Carla M Leone1, Liciana V A Silveira2

  • 1Laboratory of Epidemiology and Biostatistics National Institute of Gastroenterology, "S de Bellis" Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA, Italy (Alberto Ruben Osella, Caterina Bonfiglio, Carla Maria Leone, Rocco Guerra, Irene Bruno Claudia Buongiorno, Angelo Campanella, Vito Maria Bernardo Guerra, Valentina Deflorio, Isabella Franco, Antonella Bianco, Antonella Mirizzi, Paolo Sorino).

Nutrition, Metabolism, and Cardiovascular Diseases : NMCD
|August 22, 2020
PubMed

Insights

High remnant cholesterol (RC) significantly increases cardiovascular death risk, even with cholesterol-lowering therapies. Competing risk analysis helps understand this association among various causes of death.

Area of Science:

  • Cardiology
  • Epidemiology
  • Biostatistics

Background:

  • Cardiovascular diseases (CVDis) are a primary cause of death globally.
  • Residual risk persists despite cholesterol-lowering treatments, potentially linked to remnant cholesterol (RC).
  • Understanding RC's impact is crucial for refining cardiovascular risk assessment.

Purpose of the Study:

  • To evaluate the association between remnant cholesterol (RC) and the risk of cardiovascular deaths (CVDs).
  • To analyze RC's effect while considering competing risks like cancer deaths (CDs) and other-cause deaths (OCDs).
  • To leverage data from two prospective cohort studies for robust estimation.

Main Methods:

  • Data from 5729 subjects across two cohorts (1992 and 2005) were analyzed.
  • Remnant cholesterol (RC) levels were measured from fasting blood samples at baseline.
  • Flexible parametric competing-risks models were employed, using age at death as the time axis.

Main Results:

  • A total of 861 deaths were recorded, including 234 CVDs, 245 CDs, and 271 OCDs.
  • Elevated RC (≥1.29 mmol/L) was identified as a significant risk factor specifically for CVDs (Risk 2.54).
  • A significant trend in CVD risk was observed with increasing RC levels (Trend 1.26).

Conclusions:

  • Remnant cholesterol (RC) is a potent, independent predictor of cardiovascular mortality.
  • Competing risk analysis effectively differentiates the impact of RC on various mortality outcomes.
  • These findings underscore the importance of managing RC for reducing cardiovascular death risk.
Abstract

Keywords:
Cause-specific mortalityCompeting-risksRemnant cholesterolSurvival analysis

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