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. 2025 Jan 2;24(1):1.
doi: 10.1186/s12933-024-02556-w.

Longitudinal changes in remnant cholesterol and the risk of cardiovascular disease

Yijun Zhang  1   2   3   4 , Qin Xu  1   2   3 , Xue Tian  1   2   3   4 , Xue Xia  1   2   3 , Shuohua Chen  5 , Fen Liu  6 , Shouling Wu  7 , Anxin Wang  8   9   10
Affiliations

Longitudinal changes in remnant cholesterol and the risk of cardiovascular disease

Yijun Zhang et al. Cardiovasc Diabetol. .

Abstract

Background and aim: The analyses of longitudinal changes in remnant cholesterol (RC) and cardiovascular disease (CVD) remains are limited. The objective of the study was to investigate the associations of longitudinal changes in RC with the risks of CVD and its subtypes (myocardial infarction [MI] and stroke).

Methods and results: The participants were enrolled in the Kailuan study. The RC short-term change pattern was defined by RC cutoff points according to equivalent percentiles for low-density lipoprotein cholesterol of 2.6 mmol/L at visits in 2006 and 2008. The RC long-term change pattern was defined as the RC trajectories from 2006 to 2010. Multivariate Cox proportion models were used to calculate hazard ratios (HRs) and their 95% confidence intervals (CIs). The cutoff values of RC were 0.52 mmol/L at the 2006 visit and 0.51 mmol/L at the 2008 visit. In the RC short-term change analysis, the participants in the high stable group had a 31% increased risk of CVD (HR 1.31; 95% CI 1.22-1.41), 73% increased risks of MI (HR 1.73; 95% CI 1.47-2.03), and 21% increased risks of stroke (HR 1.21; 95% CI 1.12-1.31) compared with participants in the low stable group. Three RC trajectories were employed in the RC long-term change analysis. Compared with the low stable group, the high stable group had a 1.34-fold risk of CVD (HR 1.34; 95% CI 1.17-1.53), 1.66-fold risk of MI (HR 1.66; 95% CI 1.24-2.21), and 1.22-fold risk of stroke (HR 1.22; 95% CI 1.05-1.42).

Conclusions: The stable high RC was associated with a higher risk of CVD. Maintaining optional RC levels could reduce the lifetime risk of CVD and prolong the year of life free from CVD.

Keywords: Cardiovascular disease; Longitudinal; Remnant cholesterol; Trajectory.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The Kailuan study was performed according to the guidelines of the Helsinki Declaration and was approved by the Ethics Committee of Kailuan Hospital (approval number: 2006e05) and Beijing Tiantan Hospital (approval number: 2010–014–01). Each participant provided their written informed consent before participating in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Trajectories of remnant cholesterol from 2006 to 2010
Fig. 2
Fig. 2
Incidence rates and adjusted hazards ratios (OR) and 95% confidence intervals (CIs) of cardiovascular disease according to change in remnant cholesterol from 2006 to 2008. Adjusted ORs and 95% CIs were adjusted for age, sex, education, smoking status, drinking status, physical activity, body mass index, systolic blood pressure, fasting blood glucose, high-sensitivity C-reactive protein, hypertension, hyperlipidemia, and diabetes
Fig. 3
Fig. 3
Incidence rates and adjusted hazards ratios (OR) and 95% confidence intervals (CIs) of cardiovascular disease according to trajectories of remnant cholesterol from 2006 to 2008. Adjusted ORs and 95% CIs were adjusted for age, sex, education, smoking status, drinking status, physical activity, body mass index, systolic blood pressure, fasting blood glucose, high-sensitivity C-reactive protein, hypertension, hyperlipidemia, and diabetes
Fig. 4
Fig. 4
Subgroup analyses for the association between change in remnant cholesterol from 2006 to 2008 with the cardiovascular diseases risk. HR hazard ratio, CI confidence interval, BMI body mass index. Adjusted for age, sex, education, smoking status, drinking status, physical activity, body mass index, systolic blood pressure, fasting blood glucose, high-sensitivity C-reactive protein, hypertension, hyperlipidemia, and diabetes other than the variable for stratification
Fig. 5
Fig. 5
Subgroup analyses for the association between trajectories of remnant cholesterol from 2006 to 2012 with the cardiovascular diseases risk. HR hazard ratio, CI confidence interval, BMI body mass index. Adjusted for age, sex, education, smoking status, drinking status, physical activity, body mass index, systolic blood pressure, fasting blood glucose, high-sensitivity C-reactive protein, hypertension, hyperlipidemia, and diabetes other than the variable for stratification
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