Associations of remnant cholesterol with cardiovascular and cancer mortality in a nationwide cohort

Tian, Yuan; Wu, Yi; Qi, Minjie; Song, Lijuan; Chen, Bowang; Wang, Chunqi; Lu, Jiapeng; Yang, Yang; Zhang, Xiaoyan; Cui, Jianlan; Xu, Wei; Yang, Hao; He, Wenyan; Zhang, Yan; Zheng, Xin; Zhang, Haibo; Guo, Yuanlin; Li, Xi

doi:10.1016/j.scib.2023.12.035

Cited by 18 publications

(4 citation statements)

References 35 publications

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“…Tian et al. found that people with hypertension and diabetes had a higher level of RC ( 25 ). Interestingly, the study showed that people who never drank alcohol people are more likely to have higher RC.…”

Section: Discussionmentioning

confidence: 99%

“…Observational studies have shown that lower HDL-C levels are associated with higher cancer mortality ( 34 ), and lower HDL-C may cause higher cancer mortality at higher RC levels. On the contrary, a Chinese cohort suggested that higher levels of RC were associated with lower cancer mortality ( 25 ). Because cholesterol is essential in regulating immune cell function, high serum cholesterol levels enhance the antitumor function of natural killer cells ( 38 ).…”

Section: Discussionmentioning

confidence: 99%

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Remnant cholesterol and all-cause mortality risk: findings from the National Health and Nutrition Examination Survey, 2003-2015

Bai,

Liao,

Wang

et al. 2024

Front. Endocrinol.

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AimsCholesterol carried in triglyceride-rich lipoproteins, also called remnant cholesterol, is increasingly acknowledged as an important causal risk factor for atherosclerosis. Elevated remnant cholesterol, marked by elevated plasma triglycerides, is associated causally with an increased risk of atherosclerotic cardiovascular disease. However, the association with all-cause mortality and cause-specific mortality is inconclusive. This study aimed to test the hypothesis that remnant cholesterol levels and plasma triglycerides are associated with increased all-cause mortality and mortality from cardiovascular disease, cancer, and other causes.Methods and resultsUsing a contemporary population-based cohort, 7,962 individuals from the National Health and Nutrition Examination Survey (NHANES) aged over 40 years at baseline in 2003–2015 were included. During up to 109.2 (± 1.44) months of follow-up, 1,323 individuals died: 385 individuals died from cardiovascular disease, 290 from cancer, 80 from cerebrovascular disease, and 568 from other causes. Compared with the middle tertile remnant cholesterol level, multivariable-adjusted mortality hazard ratios were 1.20 (95% confidence interval 1.02–1.40) for all-cause mortality. For the highest tertile remnant cholesterol level, multivariable-adjusted mortality hazard ratios were 1.21 (95% confidence interval 1.05,1.40). Our conclusions remained stable in subgroup analyses. Exploratory analysis of the cause of death subcategories showed corresponding hazard ratios of 1.25 (1.13–1.38) for Non-cardiovascular and Non-cerebrovascular Death for lower remnant cholesterol individuals, 1.47 (1.01–2.15) for cancer death for lower remnant cholesterol (RC) individuals, and 1.80 (1.36–2.38) for cancer death for higher RC individuals.ConclusionRC levels were associated with U-shaped all-cause mortality. RC was associated with mortality from non-cardiovascular, non-cerebrovascular, and cancer, but not from cardiovascular causes. This novel finding should be confirmed in other cohorts.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Remnant cholesterol and all-cause mortality risk: findings from the National Health and Nutrition Examination Survey, 2003-2015

Bai,

Liao,

Wang

et al. 2024

Front. Endocrinol.

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“…Residual cholesterol (RC), the cholesterol in triglyceride-rich lipoproteins, is associated with various diseases, including metabolic, cardiovascular, and other disorders [ 13 – 15 ]. RC was shown to be an equal or even more reliable cardiovascular disease predictor than LDL-C or TC [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

The association between remnant cholesterol and bone mineral density in US adults: the National Health and Nutrition Examination Survey (NHANES) 2013–2018

Xiao,

Wang,

et al. 2024

Lipids Health Dis

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Background Previous evidence showed a possible link of dyslipidemia with bone health. Nevertheless, the correlation of remnant cholesterol (RC) with bone mineral density (BMD) has yet to be well investigated. This study investigated the association of RC with total spine BMD in general Americans. Methods This study explored the relationship of RC with total spine BMD in subjects aged ≥ 20 years from the National Health and Nutrition Examination Survey (NHANES) 2013–2018. After adjusting for covariates, multivariate linear regression and stratified analyses were conducted to determine the correlation of serum RC with total spine BMD in adult Americans. Restricted cubic spline (RCS) was applied to examine the nonlinear association of serum RC with total spine BMD. Results This study included 3815 individuals ≥ 20 years old, 1905 (49.93%) of whom were men and 1910 (50.07%) of whom were women. After adjusting for all covariates, the results showed a negative relationship of serum RC with total spine BMD (β= -0.024, 95% CI: -0.039, -0.010). The interaction tests of age, sex, race, and BMI showed no statistically significant effects on the association. The RCS also indicated a negative linear correlation of serum RC with total spine BMD (nonlinear P = 0.068, overall P < 0.001). Moreover, RC had a stronger effect on total spine BMD than total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C). Conclusions This study found that serum RC was negatively related to total spine BMD in U.S. adults. These findings emphasized the important role of RC in bone health in American adults.

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“…Lipid disorders, especially those involving elevated cholesterol and low-density lipoprotein cholesterol (LDL-C), are major causal risk factors in the onset and progression of atherosclerotic cerebrovascular disease 1 . Especially，the atherogenic potential of remnant cholesterol (RC), carried in chylomicrons, chylomicron remnants, very low-density lipoprotein (VLDL), and intermediate-density lipoprotein (IDL), is being increasingly acknowledged [2][3][4][5] . Higher RC levels may partially explain the significant residual risk factors for atherosclerosis among statin-treated individuals, even in the context of aggressive lipid-lowering treatment to reach LDL-C targets 6,7 .…”

Section: Introductionmentioning

confidence: 99%

Elevated remnant cholesterol improves prognosis of patients with ischemic stroke and malnutrition: a cohort-based study

Niu,

Wang,

Yang

et al. 2024

Preprint

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BackgroundAggressive lipid-lowering therapy is recommended for patients with ischemic stroke; however, lipid paradox has been reported in several clinical studies. The mechanism of lipid paradox remains uncertain, and nutrition maybe one explanation. In this prospective cohort study, we explored the associations between baseline remnant cholesterol (RC) concentrations and clinical outcomes in patients with ischemic stroke, stratified by nutritional status.Materials and MethodsA total of 5257 patients with ischemic stroke were recruited for analysis. The Controlling Nutritional Status (CONUT) score was utilized to investigate the risk of malnutrition. Individuals were classified into 4 groups based on their CONUT score. Poor outcomes and all-cause mortality were compared among patients with varied nutritional status and RC levels.ResultsPatients with moderate-severe malnutrition had the highest incidences of in-hospital complications, including pulmonary infection, renal dysfunction, and hemorrhagic transformation, and the highest rates of poor outcomes (61.3%,P<0.001) and all-cause mortality (32.8%,P< 0.001) during the 3-month follow-up period. Baseline higher RC level was an independent protective factor of adverse clinical outcomes for patients with any degree of malnutrition, which was not observed in patients without malnutrition. In addition, compared with the moderate-severe malnourished with RC <0.471 mmol/L, the adjusted ORs for poor outcomes and all-cause mortality were 0.805 (0.450–1.438) and 0.898 (0.502-1.607) for participants with 0.471-0.632 mmol/L, 0.259 (0.095-0.704) and 0.222 (0.061-0.810) for 0.633-0.868 mmol/L, and 0.160 (0.037–0.689) and 0.202 (0.042-0.967) for ≥ 0.869 mmol/L, prospectively.ConclusionLipid paradox was only observed in the malnourished patients with ischemic stroke. Strict lipid reduction therapy is still recommended for patients with ischemic stroke and good nutritional status. However, when treating patients at any risk of malnutrition, the improvement of nutritional status may be more crucial than aggressive lipid control.

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Associations of remnant cholesterol with cardiovascular and cancer mortality in a nationwide cohort

Cited by 18 publications

References 35 publications

Remnant cholesterol and all-cause mortality risk: findings from the National Health and Nutrition Examination Survey, 2003-2015

Remnant cholesterol and all-cause mortality risk: findings from the National Health and Nutrition Examination Survey, 2003-2015

The association between remnant cholesterol and bone mineral density in US adults: the National Health and Nutrition Examination Survey (NHANES) 2013–2018

Elevated remnant cholesterol improves prognosis of patients with ischemic stroke and malnutrition: a cohort-based study

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