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Remnant Cholesterol, C-Reactive Protein, and Risks of Lung Cancer Morbidity and Mortality Among Women: A Prospective
Ranran Qie1, Hongwei Liu1, Yin Liu1
1Department of Cancer Epidemiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Henan International Joint Laboratory of Cancer Prevention, Zhengzhou, 450008, China.
Introduction:
Previous studies have highlighted the importance of blood lipid levels in lung cancer. However, evidence of the association between remnant cholesterol and lung cancer remains scarce. This study aimed to investigate the association of remnant cholesterol with lung cancer morbidity and mortality and to evaluate their joint effects with C-reactive protein in women.
Methods:
This prospective cohort study included 198,154 women initially without cancer from the UK Biobank. Remnant cholesterol was calculated as non-high-density lipoprotein cholesterol minus the measured low-density lipoprotein cholesterol. Cox models were adopted to estimate hazard ratios and 95% CIs for the incidence of lung cancer. Data were collected between 2006 and 2022 and analyzed in 2025.
Results:
During a median follow-up of 11.80-13.90 years, 1,552 lung cancer cases and 1,074 related deaths were identified. Remnant cholesterol was positively associated with lung cancer morbidity and mortality in a linear manner, with respective hazard ratios (95% CIs) of 1.50 (1.23, 1.82) and 1.40 (1.11, 1.77) in Quartile 4. Compared with the low remnant cholesterol/low C-reactive protein group, the risk of incident lung cancer and lung cancer mortality increased by 115% and 102%, respectively, in the high remnant cholesterol/high C-reactive protein group. The cumulative risks of lung cancer by age 80 years were higher in the high remnant cholesterol/high C-reactive protein group than in the low remnant cholesterol/low C-reactive protein group (morbidity=3.64% vs 1.56%; mortality=1.97% vs 0.82%).
Conclusions:
This study found linear and positive associations of remnant cholesterol with lung cancer morbidity and mortality among women. The combination of high remnant cholesterol and C-reactive protein conferred the highest relative and absolute risks. These findings highlighted the importance of considering the combination of remnant cholesterol and C-reactive protein levels for the primary prevention of lung cancer and selection of high-risk populations for lung cancer screening among women.
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