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Long-term association of remnant cholesterol with all-cause and cardiovascular disease mortality: a nationally
Min Chen1,2, Zhi Chen1,2, Huarong Ye3
1Department of Cardiology, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China.
Insights
Elevated remnant cholesterol (RC) increases long-term risk for all-cause, cardiovascular disease (CVD), and ischemic heart disease (IHD) mortality, even with normal low-density lipoprotein cholesterol (LDL-C). Measuring RC may improve early CVD risk assessment.
Area of Science:
- Cardiology
- Preventive Medicine
- Biochemistry
Background:
- Residual cardiovascular risk persists despite achieving normal low-density lipoprotein cholesterol (LDL-C) levels.
- Remnant cholesterol (RC) is implicated as a potential contributor to this residual risk.
- The long-term association between RC and mortality requires further elucidation.
Purpose of the Study:
- To investigate the long-term association between remnant cholesterol (RC) and all-cause, cardiovascular disease (CVD), and ischemic heart disease (IHD) mortality.
- To determine if this association persists independently of other risk factors and across different LDL-C strata.
Main Methods:
- Analysis of a nationally representative sample of 13,383 US adults from NHANES III (1988-1994).
- Ascertainment of mortality causes through linkage to death records up to December 31, 2019.
- Weighted Cox proportional hazard models used to assess the relationship between RC levels and mortality outcomes.
Main Results:
- During a median follow-up of 26.6 years, 5,044 deaths occurred, including 1,741 CVD deaths.
- Participants in the highest RC quartile (≥29.80 mg/dl) showed significantly increased multivariable-adjusted HRs for all-cause mortality (1.23) and IHD mortality (1.32) compared to the lowest quartile (<14.26 mg/dl).
- Elevated RC levels were associated with increased CVD and IHD mortality risk, independent of LDL-C levels.
Conclusions:
- Elevated blood RC is linked to a higher long-term risk of all-cause, CVD, and IHD mortality.
- This association remains robust across various risk factors and LDL-C levels.
- Measuring RC may enhance clinical assessment of early cardiovascular disease risk.
Background And Objectives:
Despite reducing low-density lipoprotein cholesterol (LDL-C) to the normal range, residual cardiovascular risk remain. Remnant cholesterol (RC) exerts a potential residual risk for cardiovascular disease (CVD) prevention, and the long-term longitudinal association between RC and mortality has yet to be well elucidated.
Methods:
This study examined a nationally representative sample of 13,383 adults aged 20 years or older (mean age 45.7 and 52% women) who participated in the NHANES III (from1988 to1994). Causes of death were ascertained by linkage to death records through December 31, 2019. The relations of RC with all-cause and CVD mortality were tested using weighted Cox proportional hazard models.
Results:
Through a median follow-up of 26.6 years, 5,044 deaths were reported, comprising 1,741 deaths of CVD [1,409 deaths of ischemic heart disease (IHD) and 332 deaths of stroke] and 1,126 of cancer. Compared to those with RC <14.26 mg/dl (lowest quartile), participants with RC ≥29.80 mg/dl (highest quartile) had multivariable-adjusted HRs of 1.23 (95% CI: 1.07-1.42) for all-cause mortality, 1.22 (95% CI: 0.97-1.53) for CVD mortality, and 1.32 (95% CI: 1.03-1.69) for IHD mortality, and 0.89 (95% CI: 0.55-1.43) for stroke mortality, and 1.17 (95% CI 0.90-1.52) for cancer mortality. We observed that elevated RC levels increased CVD risk and IHD mortality despite LDL-C being in the normal range.
Conclusions:
Elevated blood RC was associated with an increased long-term risk of all-cause, CVD, and IHD mortality. These associations were independent of socioeconomic factors, lifestyles, and history of diseases, and remained robust across the LDL-C stratum. Measuring RC levels might favor clinical assessment of early CVD risk. Further investigation is needed to elucidate the optimal range of RC levels for cardiovascular disease health in the general population.
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