Remnant Cholesterol Predicts Long-term Mortality of Patients With Metabolic Dysfunction–associated Fatty Liver Disease

Abstract

Context Elevated serum remnant cholesterol independently predicts risks of cardiovascular diseases. However, the association between remnant cholesterol and metabolic dysfunction-associated fatty liver disease (MAFLD) remains unclear. Objectives This study aimed to explore the association of remnant cholesterol with MAFLD and its long-term mortality. Methods We extracted data from the NHANES Ⅲ, 1988−1994 and the linked mortality data till December 31, 2015. The association between remnant cholesterol and MAFLD was analyzed by multivariate logistic regression. Cox proportional hazards regression was performed to assess whether elevated remnant cholesterol increased all-cause and cause-specific mortalities in MAFLD patients. Results At baseline, 28.6% (1474/5156) of participants had MAFLD. In multivariate logistic regression, the fourth quartile of remnant cholesterol was associated with an increased risk of MAFLD compared with the first quartile (OR: 1.714, 95% CI: 1.586–1.971; P <0.001). In participants with normal levels of triglyceride, LDL- and HDL-cholesterol, the relationship between remnant cholesterol and MAFLD risk remained significant (OR: 1.346, 95% CI: 1.248–1.761; P <0.001). During a median follow-up of 307 months, MAFLD patients with serum remnant cholesterol in the fourth quartile were associated with a higher risk of all-cause mortality (HR: 2.183, 95% CI: 1.825–2.407; P <0.001), as well as a higher risk of cardiovascular mortality (HR: 2.346, 95% CI: 2.046–2.885; P <0.001) and cancer-related mortality (HR: 2.366, 95% CI: 1.864–2.932; P <0.001) compared with MAFLD patients in the first quartile. Conclusions Remnant cholesterol was independently associated with the risk of MAFLD and predicted all-cause, cardiovascular, and cancer-related mortalities in MAFLD patients.

Association Between Remnant Cholesterol and Risk of Hyperuricemia: A Cross-Sectional Study

“…Some scholars suggest that RC, rather than LDL-c, is linked to the development of cardiovascular disease [11]. Further studies have confirmed that RC not only predicts the risk for cardiovascular disease, but also the risk of metabolic disease [13,23,24]. Hyperuricemia and cardiovascular diseases share common risk factors [25].…”

Association of metabolic dysfunction-associated fatty liver disease with chronic kidney disease: a Chinese population-based study

“…Recent studies have confirmed that remnant cholesterol, not HDL-C or LDL-C, is significantly associated with an increased risk of CVD [ 17 , 18 ]. A higher level of remnant cholesterol was also related to the prevalence of CKD in a general middle-aged population [ 19 ] and was predictive of all-cause, cardiovascular-related, and cancer-related mortality in individuals with MAFLD [ 20 ]. In our study, we demonstrated that remnant cholesterol was independently related to an increased risk of CKD in all subjects after PSM, as well as in individuals with MAFLD with DM or prediabetes, which suggests that elevated serum remnant cholesterol might contribute to the development of CKD in subjects with MAFLD.…”

Triglyceride-rich lipoproteins, remnant-cholesterol, and atherosclerotic cardiovascular disease

“…In a secondary analysis of PREDIMED study, a primary prevention trial, the Rem-C at least 30 mg/dl was associated with increased MACE events (HR 1.89), independently of LDL-C 100 or less or greater than 100 mg/dl [24]. In a 25-year observational cohort of high-risk NHANES cohort, a similar Rem-C level 33 versus 22 mg/dl was associated with a 2.35-fold increased rate of cardiovascular deaths and a 2.18-fold increased risk of allcause deaths [25], with a much weaker relationship with triglyceride levels. Finally in a cohort of type 2 diabetes mellitus and recent-onset CKD (stage 3-5), Rem-C versus > 30 mg/dl was associated with a multivariate-adjusted OR of 1.70 for cardiovascular deaths after a follow-up of less than 2.0 years, which remained significant regardless of LDL-C or >100 mg/dl [26].…”