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Remnant Cholesterol and Atherosclerotic Cardiovascular Disease Risk in Populations With Different Low-Density
Hong Zheng1,2, Guanlin Chen1,2, Zhenyu Huo3
1Department of Cardiology Second Affiliated Hospital of Shantou University Medical College Shantou China.
Insights
Remnant cholesterol (RC) does not significantly increase atherosclerotic cardiovascular disease (ASCVD) risk in borderline-high LDL-C individuals. However, even low RC levels elevate ASCVD risk in high LDL-C populations.
Area of Science:
- Cardiology
- Lipidology
- Preventive Medicine
Background:
- Low-density lipoprotein cholesterol (LDL-C) and remnant cholesterol (RC) are established risk factors for atherosclerotic cardiovascular disease (ASCVD).
- The independent contribution of RC to ASCVD risk across varying LDL-C levels requires further elucidation.
Purpose of the Study:
- To evaluate the incremental risk stratification value of remnant cholesterol (RC) in individuals with elevated low-density lipoprotein cholesterol (LDL-C).
- To assess whether RC provides additional ASCVD risk information across different sexes, age groups, and LDL-C categories.
Main Methods:
- A cohort study involving 12,743 participants with elevated LDL-C (≥3.4 mmol/L) and 50,073 controls.
- Participants were stratified by RC levels (<0.5, 0.5 to <1.0, and ≥1.0 mmol/L).
- Kaplan-Meier curves and Cox proportional hazards models analyzed the association between RC and ASCVD risk.
Main Results:
- In the borderline-high LDL-C group (3.4–4.1 mmol/L), the lowest RC levels showed no significant ASCVD risk increase compared to controls.
- This lack of increased risk with low RC was consistent across sexes and ages in the borderline-high LDL-C group.
- In the high LDL-C group (≥4.1 mmol/L), even the lowest RC levels were associated with significantly higher ASCVD risk (HR 1.20).
Conclusions:
- Remnant cholesterol (RC) does not appear to significantly alter ASCVD risk in individuals with borderline-high LDL-C.
- Even at the lowest levels, RC remains a significant risk factor for ASCVD in individuals with high LDL-C.
- These findings highlight the importance of considering both LDL-C and RC levels for comprehensive ASCVD risk assessment.
Background:
Low-density lipoprotein cholesterol (LDL-C) and remnant cholesterol (RC) are risk factors for atherosclerotic cardiovascular disease (ASCVD). However, the extent to which differences in RC levels affect ASCVD risk in populations with varying degrees of LDL-C elevation remains unclear. This study aimed to investigate whether RC can provide additional risk stratification value across different sexes, ages, and elevated LDL-C statuses.
Methods:
This study included 12 743 elevated LDL-C participants (LDL-C ≥3.4 mmol/L) and 50 073 age- and sex-matched non-elevated LDL-C controls from the Kailuan Study. Elevated LDL-C participants were categorized by RC levels into <0.5, 0.5 to <1.0, and ≥1.0 mmol/L subgroups. Kaplan-Meier curves and Cox proportional hazards models were used to assess the relationship between RC levels and ASCVD risk across different sexes, ages, and high LDL-C statuses.
Results:
During a median follow-up of 12.8 years, 1686 elevated LDL-C participants (13.2%) and 5252 non-elevated LDL-C participants (10.5%) developed ASCVD. In the borderline-high LDL-C group (3.4 ≤ LDL-C < 4.1 mmol/L), those with the lowest RC levels showed no significant risk difference compared with controls (hazard ratio [HR], 1.03 [95% CI, 0.93-1.13]), and this pattern remained consistent across different sexes and ages. In contrast, in the high LDL-C group (LDL-C ≥4.1 mmol/L), even when RC was at the lowest level, ASCVD risk remained significantly higher than that of controls (HR, 1.20 [95% CI, 1.02-1.41]).
Conclusions:
In the borderline-high LDL-C population, those with the lowest RC levels showed no significant risk difference compared with controls, and this pattern remained consistent across different sexes and age subgroups. In the high LDL-C population, even when RC was at the lowest level, ASCVD risk remained significantly higher than that of controls.
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