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Predictive value of remnant cholesterol inflammatory index for stroke risk: Evidence from the China health and
Jiaying Chen1, Qiheng Wu2, Haotian Liu2
1Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China; Comprehensive Medical Treatment Ward, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
Insights
A new Remnant Cholesterol Inflammatory Index (RCII) combining remnant cholesterol and hs-CRP predicts stroke risk. Higher RCII levels, both initially and over time, significantly increase the likelihood of experiencing a stroke.
Area of Science:
- Cardiovascular Medicine
- Biomarkers
- Epidemiology
Background:
- Remnant cholesterol (RC) and high-sensitivity C-reactive protein (hs-CRP) are known stroke risk factors.
- The combined impact of RC and hs-CRP on stroke risk requires further investigation.
Purpose of the Study:
- To introduce and evaluate the Remnant Cholesterol Inflammatory Index (RCII) for predicting stroke risk.
- To assess the predictive value of RCII, integrating RC and hs-CRP, in a large cohort.
Main Methods:
- Analysis of 9,898 participants (aged ≥45, no prior stroke) from the China Health and Retirement Longitudinal Study (CHARLS).
- Calculation of RCII using the formula: RCII = RC (mg/dL) × hs-CRP(mg/L)/10.
- Assessment of baseline and cumulative RCII associations with stroke risk using Cox regression and ROC analysis.
Main Results:
- A median 7-year follow-up revealed 560 incident strokes, with incidence rising across RCII quartiles.
- Each SD increase in RCII was linked to a 10.6% higher stroke risk (HR=1.106).
- Cumulative RCII >36.14 significantly increased stroke risk (HR=1.462); associations were stronger in males.
Conclusions:
- Elevated baseline and cumulative RCII levels are significant predictors of increased stroke risk.
- The RCII demonstrates potential as a valuable tool for stroke risk stratification.
- Early intervention strategies targeting high RCII individuals may help mitigate stroke incidence.
Introduction:
Remnant cholesterol (RC) and high-sensitivity C-reactive protein (hs-CRP) are established stroke risk factors, but their joint impact remains unclear.
Objectives:
This study aimed to evaluate the predictive value of the remnant cholesterol inflammatory index (RCII), a novel index integrating RC and hs-CRP, in assessing stroke risk.
Methods:
We analyzed 9,898 participants aged 45 years or older, with no history of stroke at baseline, from the China Health and Retirement Longitudinal Study (CHARLS). RCII was calculated using the formula: RCII = RC (mg/dL) × hs-CRP(mg/L)/10. A subset of 5,704 participants was studied to investigate the relationship between cumulative RCII exposure and stroke incidence. The associations of both baseline and cumulative RCII with stroke risk were assessed using Cox proportional hazards regression model.
Results:
During a median 7-year follow-up, 560 participants (5.7 %) experienced an incident stroke. Stroke incidence escalated with increasing RCII quartiles, from 3.5 % (Q1) to 7.6 % (Q4). In multivariable-adjusted analyses, each standard deviation increase in RCII was significantly associated with a 10.6 % increased risk of stroke (HR = 1.106, 95 % CI: 1.048-1.167). ROC analysis revealed that RCII had the highest AUC at 0.581, higher than RC (0.566) and hs-CRP (0.560), though the difference with RC was not statistically significant (P = 0.166). Mediation analysis indicated a reciprocal mediation between RC and hs-CRP on stroke risk. In a 3-year subset analysis, 288 participants suffered a stroke. Participants with cumulative RCII levels exceeding 36.14 had a significantly increased risk of incident stroke (HR = 1.462, 95 % CI: 1.102-1.939). Subgroup analyses showed a significant positive association between elevated RCII levels and stroke risk in males, but not in females.
Conclusions:
Elevated levels of RCII, both at baseline and cumulative, are significantly associated with an increased risk of stroke. Early intervention in patients with high RCII may further help reduce stroke risk.
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