期刊
EUROPEAN HEART JOURNAL
卷 42, 期 42, 页码 4324-+出版社
OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/ehab432
关键词
LDL-cholesterol; Remnant cholesterol; Apolipoprotein B; Primary prevention
资金
- NIH T32 training grant [5T32HL007227]
- National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services [HHSN268 201700001I, HHSN268201700002I, HHSN268201700003I, HHSN 268201700005I, HHSN268201700004I]
- National Heart, Lung, and Blood Institute [75N92020D00001, HHSN268201500003I, N01-HC-95159, 75N92020D00005, N01HC-95160, 75N92020D00002, N01-HC-95161, 75N92020D00003]
- National Center for Advancing Translational Sciences (NCATS) [UL1-TR-000040, UL1-TR-001079, UL1-TR-001420]
- National Heart, Lung, and Blood Institute (NHLBI)
- University of Alabama at Birmingham [HHSN268201300025C, HHSN268201300026C]
- Northwestern University [HHSN268201300027C]
- University of Minnesota [HHSN268201300028C]
- Kaiser Foundation Research Institute [HHSN268201300029C]
- Johns Hopkins University School of Medicine [HHSN268200900041C]
- Intramural Research Program of the National Institute on Aging (NIA)
- NIA [AG0005]
- NHLBI [AG0005]
- The National Heart, Lung, and Blood Institute [N01-HC-95162, 75N92020D00006, N01-HC-95163, 75N92020 D00004, N01-HC-95164, 75N92020D00007, N01-HC-95165, N01HC-95166, N01-HC-95167, N01-HC-95168, N01-HC-95169]
High remnant cholesterol (RC) levels are associated with ASCVD in individuals without known ASCVD, independent of traditional risk factors, LDL-C, and apoB levels. The discordant group with high RC/low LDL-C, but not the low RC/high LDL-C group, showed increased ASCVD risk compared to the concordant group.
Aims Emerging evidence suggests that remnant cholesterol (RC) promotes atherosclerotic cardiovascular disease (ASCVD). We aimed to estimate RC-related risk beyond low-density lipoprotein cholesterol (LDL-C) and apolipoprotein B (apoB) in patients without known ASCVD Methods and results We pooled data from 17 532 ASCVD-free individuals from the Atherosclerosis Risk in Communities study (n = 9748), the Multi-Ethnic Study of Atherosclerosis (n = 3049), and the Coronary Artery Risk Development in Young Adults (n = 4735). RC was calculated as non-high-density lipoprotein cholesterol (non-HDL-C) minus calculated LDL-C. Adjusted Cox models were used to estimate the risk for incident ASCVD associated with log RC levels. We also performed discordance analyses examining relative ASCVD risk in RC vs. LDL-C discordant/concordant groups using difference in percentile units (>10 units) and clinically relevant LDL-C targets. The mean age of participants was 52.3 +/- 17.9 years, 56.7% were women and 34% black. There were 2143 ASCVD events over the median follow-up of 18.7 years. After multivariable adjustment including LDL-C and apoB, log RC was associated with higher ASCVD risk [hazard ratio (HR) 1.65, 95% confidence interval (CI) 1.45-1.89]. Moreover, the discordant high RC/low LDL-C group, but not the low RC/high LDL-C group, was associated with increased ASCVD risk compared to the concordant group (HR 1.21, 95% CI 1.08-1.34). Similar results were shown when examining discordance across clinical cutpoints Conclusions In ASCVD-free individuals, elevated RC levels were associated with ASCVD independent of traditional risk factors, LDL-C, and apoB levels. The mechanisms of RC association with ASCVD, surprisingly beyond apoB, and the potential value of targeted RC-lowering in primary prevention need to be further investigated.
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