The Association Between Remnant Cholesterol and the Estimated 10-Year Risk of a First Hard Cardiovascular Event

Abstract

Background: Remnant cholesterol (Remnant-C), rather than TG, is believed to increase the risk of atherosclerotic cardiovascular disease. We evaluated whether Remnant-C is associated with an estimated 10-year risk of a first hard atherosclerotic cardiovascular disease event.

Methods: This cross-sectional study was performed on 2,048 participants (1,130 men and 918 women), aged 40 to 79 years, from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2018. The independent variable was Remnant-C; the dependent variable was the 10-year risk of a first hard atherosclerotic cardiovascular disease event (defined as non-fatal myocardial infarction, coronary heart disease death, or stroke, over a 10-year period among people free from atherosclerotic cardiovascular disease at the beginning of the period). The other variables, such as smoking behavior, hypertension, diabetes etc., were considered as the potential effect modifiers. Multivariate linear regression models and smooth curve fittings were used to evaluate the association between Remnant-C and the 10-year risk of a first hard atherosclerotic cardiovascular disease event. Subgroup analyses stratified by gender and race were also performed.

Results: A positive association between Remnant-C and the 10-year risk of a first hard atherosclerotic cardiovascular disease event was demonstrated in the fully adjusted model (β = 0.078, [95%CI: 0.061-0.094], P < 0.001). The 10-year risk was increased by 0.078% for each 1 mg/dl increase in Remnant-C. In the subgroup analysis for gender, this association remained in both men (β = 0.128, [95%CI: 0.108-0.148], P < 0.001) and women (β = 0.043, [95%CI: 0.016-0.070], P = 0.00179). However, in the subgroup analysis for race, the association between Remnant-C and the 10-year risk reached an inflection point at remnant-C 38 mg/dL, where a positive association was not as obvious for the non-Hispanic Black population as for other racial groups.

Conclusions: Remnant-C positively correlates with a 10-year risk of a first hard atherosclerotic cardiovascular disease event.

Keywords: 10-year risk; NHANES; Remnant cholesterol; atherosclerotic cardiovascular disease; cross-sectional study.

Figure 1

The association between Remnant-C and the 10-year risk of a first hard ASCVD event. (A) Each black point represents a sample. (B) Solid red line represents the smooth curve fit between variables. Blue lines represent the 95% of confidence interval from the fit. Gender, age, race, body mass index, systolic blood pressure, diastolic blood pressure, hypertension treatment, smoking, diabetes, and low-density lipoprotein cholesterol were adjusted. Remnant-C, remnant cholesterol.

Figure 2

Stratified association between Remnant-C and the 10-year risk of a first hard ASCVD event. (A) stratified by gender, 1 = Men, 2 = Women. (B) stratified by race, 1 = Non-Hispanic Black, 2 = Others. Gender, age, race, body mass index, systolic blood pressure, diastolic blood pressure, hypertension treatment, smoking, diabetes, and low-density lipoprotein cholesterol were adjusted. In the subgroup analysis stratified by gender or race, the model is not adjusted for the stratification variable itself. Remnant-C, remnant cholesterol.