Association of remnant cholesterol with CVD incidence: a general population cohort study in Southwest China

Chengxi Liu; Mi Dai; Kunming Tian; Shiyu Zhou; Lei Luo; Zhiying Zeng; Xuelian Yan; Ying Xiao; Yiying Wang; Renli Deng; Xiuhong Lei; Tao Liu

doi:10.3389/fcvm.2023.1286286

Association of remnant cholesterol with CVD incidence: a general population cohort study in Southwest China

Front Cardiovasc Med. 2023 Nov 27:10:1286286. doi: 10.3389/fcvm.2023.1286286. eCollection 2023.

Authors

Chengxi Liu^#^{1

2}, Mi Dai^#³, Kunming Tian^{2

4}, Shiyu Zhou⁴, Lei Luo², Zhiying Zeng¹, Xuelian Yan³, Ying Xiao³, Yiying Wang⁵, Renli Deng⁴, Xiuhong Lei¹, Tao Liu⁵

Affiliations

¹ Department of Anesthesiology, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China.
² Department of Preventive Medicine, School of Public Health, Zunyi Medical University, Zunyi, China.
³ The Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi), Zunyi, China.
⁴ Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, China.
⁵ Department of Chronic Disease Prevention and Control, Guizhou Disease Prevention and Control, Guiyang, China.

^# Contributed equally.

Abstract

Background: Emerging evidence has indicated that remnant cholesterol (RC) could predict cardiovascular disease (CVD) incidence. Nevertheless, the relationship between RC and CVD risk, especially within the general Chinese population, remains scarce.

Objective: The present research aimed to assess whether RC concentrations and CVD outcomes in general Chinese adults are related.

Methods: The Cox proportional hazard model was established to explore the relationship between RC and the outcomes of CVD and CVD subgroups. A restricted cubic spline (RCS) was utilized to investigate the dose-response connection between RC and the risk of CVD outcomes, and the ROC curve was used to calculate the corresponding cutoff values. Moreover, stratified analysis was conducted to investigate the potential effect modification in the association between RC and CVD outcomes.

Results: Significant positive associations were found between elevated categorical RC and increased risk of CVD (HR Q4, 1.80; 95% CI 1.15-2.79; P-value = 0.008), atherosclerotic cardiovascular disease (HR Q4, 2.00; 95% CI 1.22-3.27; P-value = 0.007), stroke (HR Q4, 1.66; 95% CI 1.02-2.69; P-value = 0.040), and ischemic stroke (HR Q4, 1.87, 95% CI 1.08-3.25; P-value = 0.034), respectively. Our study suggested that the incidence of CVD outcomes increased when RC levels were above 0.75 mmol/L. Importantly, the CVD risks related to RC were more likely to be those found in subjects aged above 60 years, women, subjects with BMI <24 kg/m², and subjects with hypertension and unhealthy diet patterns.

Conclusions: Aberrant high level of RC is associated with elevated CVD risk, independent of low-density lipoprotein cholesterol (LDL-C). Our data reveal urgent primary prevention for subjects with high RC levels to a low incidence of CVD, especially for the elderly, women, and those with hypertension and unhealthy diet patterns.

Keywords: China; cardiovascular disease; cohort study; general population; remnant cholesterol.

Grants and funding

The authors declare that financial support was received for the research, authorship, and/or publication of this article.