Remnant cholesterol and risk of incident hypertension: a population-based prospective cohort study

The mediating role of remnant cholesterol in the associations of Angiopoietin-like 8 with all-cause, CVD, and cancer death: the China Cardiometabolic Disease and Cancer Cohort (4C) study

PURPOSE

To investigate the potential mediating effect of remnant cholesterol (RC) in the associations between angiopoietin-like 8 (ANGPTL8) and the risk of all-cause, cardiovascular disease (CVD), and cancer death.

METHODS

This prospective observational study included 3278 individuals from China. Binary logistic regression and mediation analyses were conducted to investigate the mediating effect of RC in the associations between ANGPTL8 and all-cause, CVD, and cancer death.

RESULTS

During up to 5-year follow-up, a total of 265 deaths (8.08%) were documented. Both increased levels of ANGPTL8 and RC were associated with a higher risk of death for all-cause, CVD, and cancer risk. The level of RC ≥ 33 mg/dL could identify individuals at a higher risk of death independent of low-density lipoprotein cholesterol (LDL-C) levels in Chinese general populations. Furthermore, RC significantly mediated the relationship between increased ANGPTL8 levels and higher risk of all-cause, CVD, and cancer death (proportion of mediation effect: 13.10%, 9.22%, and 6.07%, respectively, all p < 0.05).

CONCLUSION

Both increased circulating levels of ANGPTL8 and RC are the risk factors for all-cause, CVD, and cancer death and RC partially mediates the association between ANGPTL8 and death risk.

Remnant cholesterol and new-onset atrial fibrillation: The Atherosclerosis Risk in Communities study

BACKGROUND

The relationship between remnant cholesterol (RC) and atrial fibrillation (AF) remains unclear.

OBJECTIVE

The purpose of this study was to comprehensively explore the association between RC characteristics and new-onset AF.

METHODS

Data from 5 follow-up visits of the ARIC (Atherosclerosis Risk in Communities) study were analyzed. RC were multidimensionally evaluated in 4 characteristics: baseline level, variability, cumulative exposure, and trajectory. Baseline RC was obtained from the initial visit (V1), and new-onset AF was monitored in V2 to V5 (cohort 1, n = 14,450). RC variability, cumulative RC, and RC trajectory were calculated by RC values gathered from V1 to V3, and new-onset AF was monitored in V4 and V5 (cohort 2, n = 11,012). Participants were divided into 4 groups based on quartiles or trajectories. Cox proportional hazards analyses were used to investigate the relationship between RC characteristics and AF.

RESULTS

Following median follow-up of 22.39 years in cohort 1 and 16.71 years in cohort 2, a total of 1993 AF events in cohort 1 and 1571 in cohort 2 were identified. Participants with the highest quartile exhibited an elevated risk of new-onset AF, with the multivariable-adjusted hazard ratios of 1.16 (P = .039) for baseline RC and 1.30 (P < .001) for RC variability. Although the highest quartile of cumulative RC (P = .241) and the high-increasing trajectory (P = .210) did not demonstrate a statistically significant association with AF occurrence, they indicate a trend toward heightened risk.

CONCLUSION

Our findings reveal that higher levels of RC, particularly at baseline and in variability, are associated with an increased risk of AF.

Association between Remnant Cholesterol and Metabolic Syndrome among Chinese Adults: Chinese Nutrition and Health Surveillance (2015-2017)

BACKGROUND

Remnant cholesterol (RC) is highly associated with several chronic diseases. However, the relationship between RC and Metabolic syndrome (MetS) remains unclear. The study's objective is to illustrate the relationship of RC to MetS.

METHODS

The data were collected from the Chinese Nutrition and Health Surveillance (2015-2017), which included personal, household and dietary information. A total of 65,618 residents aged 20 years or older from 31 provinces in mainland China were included in this study. RC was calculated by the equation RC = TC - (LDL-C + HDL-C). The criteria for MetS were based on the 2020 Chinese Type 2 Diabetes Prevention and Treatment Guidelines. Logistic regression models were used to analyse the relationship between RC and MetS and every MetS component. The receiver operating characteristic (ROC) curve was established to evaluate the accuracy of RC in identifying MetS, and the area under the curve (AUC) and the best threshold were calculated.

RESULTS

The weighted RC level of Chinese residents aged 20 years or older was 0.48 mmol/L. Participants with high RC levels were likely to be elderly, have a higher prevalence of MetS, higher total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), fasting blood glucose (FBG), hba1c, and lower high-density lipoprotein cholesterol (HDL-C). Sex, body mass index (BMI), education status, household yearly income per capita, marital status, area of the country, residence location, smoking status, fruit intake and sleep time had statistical differences in the RC group (p < 0.05). The OR of MetS gradually increased with an increase in the RC quartile (p < 0.01), and higher quartiles of RC (Q4) suggested the highest MetS risk. The prevalence of each MetS component gradually increased with an increase in the RC quartile. The ROC curve found that to identify MetS, the AUC and best threshold of RC were 0.71 and 0.52 mmol/L, respectively.

CONCLUSIONS

RC had a positive association with MetS and each MetS component. The accuracy in identifying MetS was higher in RC than in other indexes. The current study could provide new scientific evidence for the early prevention and control of MetS.

Clinical biomarker profiles reveals gender differences and mortality factors in sepsis

Background

Sepsis is a major contributor to global morbidity and mortality, affecting millions each year. Notwithstanding the decline in sepsis incidence and mortality over decades, gender disparities in sepsis outcomes persist, with research suggesting higher mortality rates in males.

Methods

This retrospective study aims to delineate gender-specific clinical biomarker profiles impacting sepsis progression and mortality by examining sepsis cases and related clinical data from the past three years. Propensity score matching was used to select age-matched healthy controls for comparison.

Results

Among 265 sepsis patients, a significantly higher proportion were male (60.8%, P<0.001). While mortality did not significantly differ by gender, deceased patients were significantly older (mean 69 vs 43 years, P=0.003), more likely to have hypertension (54% vs 25%, P=0.019), and had higher SOFA scores (mean ~10 vs 4, P<0.01) compared to survivors. Principal Component Analysis (PCA) showed clear separation between sepsis patients and healthy controls. 48 serum biomarkers were significantly altered in sepsis, with Triiodothyronine, Apolipoprotein A, and Serum cystatin C having the highest diagnostic value by ROC analysis. Gender-stratified comparisons identified male-specific (e.g. AFP, HDLC) and female-specific (e.g. Rheumatoid factor, Interleukin-6) diagnostic biomarkers. Deceased patients significantly differed from survivors, with 22 differentially expressed markers; Antithrombin, Prealbumin, HDL cholesterol, Urea nitrogen and Hydroxybutyrate had the highest diagnostic efficiency for mortality.

Conclusion

These findings enhance our understanding of gender disparities in sepsis and may guide future therapeutic strategies. Further research is warranted to validate these biomarker profiles and investigate the molecular mechanisms underlying these gender differences in sepsis outcomes.

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

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.