The effects of estimated remnant-like particle cholesterol on incident cardiovascular disease: Insights from a general Chinese population
Abstract Background Growing evidence suggests that remnant cholesterol (RC) may contribute to residual atherosclerotic cardiovascular disease (ASCVD) risk. But the cut-off point to treat RC for reducing ASCVD is still not known. This study was aimed to investigate the relationships between RC and combined cardiovascular diseases (CVDs) in a general China cohort, with 11,956 subjects aged ≥ 35 years. Methods Baseline RC was estimated with the Friedewald formula for 8782 subjects. The outcome was the incidence of combined CVD, including fatal and nonfatal stroke and coronary heart disease (CHD). Cox proportional hazards model was used to calculate hazard ratios (HRs) with 95% confidence intervals. Restricted cubic spline model was used to evaluate dose-response relationship between continuous RC and the natural log of HRs. Results After a mean follow-up of 4.66 years, 431 CVD events occurred. In the cox proportional models, participants with high level of categorial RC had significantly higher risk for combined CVD (HR: 1.37; 95% CI: 1.07–1.74) and CHD (HR: 1.63; 95% CI: 1.06–2.53), compared to those with medium level of RC. In the stratification analyses, high level of RC significantly increased combined CVD risk for subgroups females, age < 65years, non-current smokers, non-current drinkers, normal weight, renal dysfunction, and no hyperuricemia. Same trends were found for CHD among subgroups males, age < 65 years, overweight, renal dysfunction, and normal uric acid; stroke for subgroup females. In the restricted cubic spline models, significantly linear association between RC and combined CVD and non-linear association between RC and CHD were shown. The risk of outcomes was relatively flat until 0.84mmol/l of RC and increased rapidly afterwards, with HR of 1.308 (1.102 to 1.553) for combined CVD and 1.411 (1.061 to 1.876) for CHD. Stratified analyses showed significant nonlinearity association between RC and CVD outcomes in subgroup aged < 65 years or subgroup diabetes. Conclusions In this large-scale and long-term follow-up cohort study, participants with higher RC levels had significantly worse prognosis, especially for subgroup aged 35–65 years or subgroup diabetes mellitus.