Cumulative remnant cholesterol predicts cardiovascular outcomes in elderly patients with atherosclerotic cardiovascular disease

Association between remnant cholesterol and metabolic dysfunction-associated steatotic liver disease in the elderly

BACKGROUND & AIMS

Whether maintaining optimal remnant cholesterol (RC) levels later in life may improve metabolic dysfunction-associated steatotic liver disease (MASLD) outcomes remained ambiguous. This study aimed to investigate the relationship between RC and MASLD in the elderly Chinese population.

METHODS

A total of 131,868 subjects aged ≥ 65 years were included in this study. The association of RC with MASLD, and severity of MASLD was analyzed by logistic regression. In addition, stratified analysis was conducted to test the potential interaction.

RESULTS

MASLD prevalence and RC concentration decreased with age. After adjustment for possible confounders, the odds ratio of MASLD at the highest quartile of RC compared to the lowest quartile was 1.587(95% CI: 1.524-1.652), and this effect remained in MASLD with liver fibrosis. Stratified analysis showed a more prominent effect on the MASLD in males, those aged 65-69 years, those without central obesity, those with diabetes, and normal level of total cholesterol, low-density lipoprotein cholesterol (Pfor interaction<0.05).

CONCLUSIONS

In the elderly subset of the Chinese population, higher RC levels achieved a significant risk effect against MASLD. More RC monitoring should be given to older for the prevention and intervention of MASLD.

Cumulative remnant cholesterol exposure during young adulthood and middle age and risk of cardiovascular events: A 30-year population-based cohort study

BACKGROUND

Remnant cholesterol (RC) is recognized as a residual risk factor for cardiovascular diseases (CVD). Most studies on the association between RC and CVD have focused on RC level at a single time point, typically during middle or older age. Limited data have characterized long-term RC exposures among young adult. Here we aimed to investigate the association of cumulative RC exposure during young adulthood and middle age with incident CVD later in life.

METHODS

This cohort study enrolled 3416 CARDIA (Coronary Artery Risk Development in Young Adults) participants aged 18-30 years. Cumulative RC exposure was determined as cumulative RC and time-weighted average (TWA) RC during young adulthood and middle age. Multivariable Cox proportional hazards models were employed to examine the association between cumulative RC exposure and incident CVD.

RESULTS

Of the 3416 included participants, 193 (5.6%) primary CVD outcomes occurred with a median 30.4-year follow-up. In multivariable Cox proportional hazards regression models that adjusted for LDL-C level, the most recent RC level and other CVD risk factors, the hazard ratios for primary CVD ourtcomes were as follows: 2.01 (95% CI, 1.23-3.27; P for trend = 0.021) for cumulative RC, and 2.11 (95% CI, 1.28-3.47; P for trend = 0.011) for TWA RC. Similar results were observed in other secondary outcomes.

CONCLUSIONS

Greater exposures to cumulative RC and TWA RC during young adulthood and middle age were independently associated with an increased risk of cardiovascular events, suggesting that maintaining low RC levels early in life may reduce the lifetime CVD risk.

Predictive utility of remnant cholesterol in atherosclerotic cardiovascular disease

PURPOSE OF REVIEW

Remnant cholesterol (RC) is the cholesterol carried in lipoproteins derived from the catabolism of chylomicrons and very low-density lipoproteins. Evidence supporting the causal relationship of RC with atherosclerotic cardiovascular disease (ASVD) is accumulating rapidly. The number of impactful contributions to this field are increasing and provide a pathophysiological insight into the current residual cardiovascular risk beyond low-density cholesterol (LDL)-cholesterol (LDL-C). They also raise the question of whether RC should be used in prediction models and become the target of new therapeutic interventions. The intent of this review is to highlight the recent advances on the role of RC in atherogenesis and the validation of RC as a predictor of ASVD.

RECENT FINDINGS

Numerous prospective and retrospective cohorts helped validate a significant causal relationship of RC with various forms of ASVD, independent of LDL-C. A recent large Mendelian randomization study reinforced the existence of this relationship and showed that the risk of atherosclerotic events was driven nearly entirely by a direct effect of RC.

SUMMARY

Both available and accumulating evidence suggest that a lifelong reduction in RC could translate into a substantial reduction in ASVD risk. The data support a revision of current guidelines to incorporate RC as an independent risk factor for ASVD. We propose that early screening of RC should be implemented and that RC lowering should become the target of future drug developments.

Cumulative remnant cholesterol burden increases the risk of cardiovascular disease among young adults

BACKGROUND

Previous studies have shown that remnant cholesterol (RC) was associated with cardiovascular disease (CVD) among middle-aged or older adults. However, lack of evidence on long-term exposures to RC and their role in CVD risk among young adults. We thus aimed to explore the association between cumulative RC burden and CVD in young adults.

METHODS

We enrolled participants younger than 45 years free of CVD history in the Kailuan Study who completed the first three health examinations from 2006 to 2010. Cumulative RC burden included cumulative RC burden score, time-weighted cumulative RC, exposure duration of high RC, and time course of RC accumulation. The outcome was the incidence of CVD. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) between cumulative RC burden and CVD risk.

RESULTS

A total of 15,219 participants were included (73.70% male, median age 39.13 years). During a median follow-up duration of 8.71 years (interquartile range: 8.4-9.15 years), 502 individuals developed CVD. After adjustment for traditional cardiovascular risk factors, highest risk of CVD was observed in participants with the highest cumulative RC burden score (HR, 1.66; 95% CI, 1.29-2.12), the highest quartile time-weighted cumulative RC (HR,1.50; 95% CI, 1.15-1.96), the longest exposure duration of high RC (HR, 1.71; 95% CI, 1.21-2.42), and those with cumulative RC burden and positive slope (HR, 1.79; 95% CI, 1.35-2.36).

CONCLUSIONS

Cumulative RC burden increased the risk of CVD among young adults, suggesting that maintaining low RC levels throughout young adulthood may minimize CVD risk.

KEY LEARNING POINTS

Higher remnant cholesterol is associated with an increased risk of amnestic mild cognitive impairment: a community-based cross-sectional study

Background and aims

Amnestic mild cognitive impairment (aMCI) is the most common subtype of MCI, which carries a significantly high risk of transitioning to Alzheimer's disease. Recently, increasing attention has been given to remnant cholesterol (RC), a non-traditional and previously overlooked risk factor. The aim of this study was to explore the association between plasma RC levels and aMCI.

Methods

Data were obtained from Brain Health Cognitive Management Team in Wuhan (https://hbtcm.66nao.com/admin/). A total of 1,007 community-dwelling elders were recruited for this project. Based on ten tools including general demographic data, cognitive screening and some exclusion scales, these participants were divided into the aMCI (n = 401) and normal cognitive groups (n = 606). Physical examinations were conducted on all participants, with clinical indicators such as blood pressure, blood sugar, and blood lipids collected.

Results

The aMCI group had significantly higher RC levels compared to the normal cognitive group (0.64 ± 0.431 vs. 0.52 ± 0.447 mmol/L, p < 0.05). Binary logistics regression revealed that occupation (P<0.001, OR = 0.533, 95%CI: 0.423-0.673) and RC (p = 0.014, OR = 1.477, 95% CI:1.081-2.018) were associated factors for aMCI. Partial correlation analysis, after controlling for occupation, showed a significant negative correlation between RC levels and MoCA scores (r = 0.059, p = 0.046), as well as Naming scores (r = 0.070, p = 0.026). ROC curve analysis demonstrated that RC levels had an independent predictive efficacy in predicting aMCI (AUC = 0.580, 95%CI: 0.544 ~ 0.615, P < 0.001).

Conclusion

Higher RC levels were identified as an independent indicator for aMCI, particularly in the naming cognitive domain among older individuals. Further longitudinal studies are necessary to validate the predictive efficacy of RC.

Cumulative residual cholesterol predicts the risk of cardiovascular disease in the general population aged 45 years and older

BACKGROUND

Numerous studies have affirmed a robust correlation between residual cholesterol (RC) and the occurrence of cardiovascular disease (CVD). However, the current body of literature fails to adequately address the link between alterations in RC and the occurrence of CVD. Existing studies have focused mainly on individual RC values. Hence, the primary objective of this study is to elucidate the association between the cumulative RC (Cum-RC) and the morbidity of CVD.

METHODS

The changes in RC were categorized into a high-level fast-growth group (Class 1) and a low-level slow-growth group (Class 2) by K-means cluster analysis. To investigate the relationship between combined exposure to multiple lipids and CVD risk, a weighted quantile sum (WQS) regression analysis was employed. This analysis involved the calculation of weights for total cholesterol (TC), low-density lipoprotein (LDL), and high-density lipoprotein (HDL), which were used to effectively elucidate the RC.

RESULTS

Among the cohort of 5,372 research participants, a considerable proportion of 45.94% consisted of males, with a median age of 58. In the three years of follow-up, 669 participants (12.45%) had CVD. Logistic regression analysis revealed that Class 2 individuals had a significantly reduced risk of developing CVD compared to Class 1. The probability of having CVD increased by 13% for every 1-unit increase in the Cum-RC according to the analysis of continuous variables. The restricted cubic spline (RCS) analysis showed that Cum-RC and CVD risk were linearly related (P for nonlinearity = 0.679). The WQS regression results showed a nonsignificant trend toward an association between the WQS index and CVD incidence but an overall positive trend, with the greatest contribution from TC (weight = 0.652), followed by LDL (weight = 0.348).

CONCLUSION

Cum-RC was positively and strongly related to CVD risk, suggesting that in addition to focusing on traditional lipid markers, early intervention in patients with increased RC may further reduce the incidence of CVD.