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Association and mediating mechanism between remnant cholesterol and first-ever stroke among the Chinese general
Heng Li1, Shuai Miao2,3, Lu Chen4
1Department of Neurology, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.
Insights
High remnant cholesterol (RC) significantly increases first-ever stroke risk in the Chinese population. This association is partly mediated by hypertension, suggesting RC as a potential target for stroke prevention.
Area of Science:
- Cardiovascular Epidemiology
- Metabolic Syndrome Research
- Public Health
Background:
- Remnant cholesterol (RC) is implicated in atherosclerosis development.
- Understanding RC's role in stroke is crucial for cardiovascular disease prevention.
Purpose of the Study:
- To evaluate the association between remnant cholesterol and first-ever stroke in the Chinese general population.
- To investigate potential mediation by hypertension and diabetes in the RC-stroke relationship.
Main Methods:
- Retrospective cohort analysis of the China Health and Nutrition Survey (7,035 participants).
- Logistic regression, propensity score methods, and doubly robust estimation were used.
- Mediation analyses identified pathways influencing the RC-stroke association.
Main Results:
- High RC was linked to a significantly higher incidence of first-ever stroke (1.4% vs. 0.8%, p=0.007).
- High RC was associated with a 74% increased stroke risk (OR, 1.74; 95% CI, 1.06-2.85).
- Hypertension significantly mediated the association between RC and stroke; diabetes did not.
Conclusions:
- Elevated remnant cholesterol increases first-ever stroke risk in the Chinese population, independent of prior cardiovascular events.
- Hypertension partially mediates the link between high RC and stroke risk.
- Remnant cholesterol may be a modifiable target for primary stroke prevention strategies.
Background:
Remnant cholesterol (RC) has been suggested to be implicated in atherosclerosis. The objective of the study was to evaluate the association between RC and first-ever stroke in the Chinese general population and to investigate whether the association is mediated via hypertension or diabetes.
Methods:
This study is a retrospective cohort analysis of participants from the China Health and Nutrition Survey. Participants without previous stroke and myocardial infarction in 2009 were enrolled and followed up in 2011 and 2015. Logistic regression analyses were adopted to explore the association of RC with stroke risk. Propensity score methods and doubly robust estimation method were used to ensure the robustness of our findings. Potential mediators were identified by mediation analyses.
Results:
A total of 7,035 participants were involved, and during 6 years of follow-up, 78 (1.1%) participants experienced a first-ever stroke. Participants with high RC had a significantly higher incidence of stroke (1.4% versus 0.8%; p = 0.007). High RC was associated with 74% higher stroke risk after adjusting for multiple relevant variables (odds ratio [OR], 1.74; 95% CI, 1.06-2.85). The association was consistent in analyses using propensity score methods and doubly robust estimation method. Hypertension showed a significant mediating effect on the association between RC and stroke, while the mediating effect of diabetes was not significant.
Conclusion:
High RC increased the risk of first-ever stroke in the Chinese general population without previous stroke and myocardial infarction, partially through the pathway of hypertension. RC might be a potential target for the primary prevention of stroke.
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