Age dependent association between remnant cholesterol and cardiovascular disease

Joint association of remnant cholesterol and lipoprotein-associated phospholipase A2 with composite adverse events: A 12-year follow-up study from Asymptomatic Polyvascular Abnormalities Community study

AIMS

To explore the association of remnant cholesterol (RC) and lipoprotein-associated phospholipase A2 (Lp-PLA2) with composite adverse events in a large-scale prospective study.

METHODS

All data were collected from the Asymptomatic Polyvascular Abnormalities Community study between 2010 and 2022. Serum cholesterol levels and Lp-PLA2 were determined by enzyme-linked immunosorbent assay. The participants were categorized into four groups based on their RC and Lp-PLA2 levels: low-RC/Lp-PLA2-, high-RC/Lp-PLA2-, low-RC/Lp-PLA2+ and high-RC/Lp-PLA2+. The composite endpoint was a combination of first-ever stroke, myocardial infarction or all-cause mortality. Cox regression analyses were performed to evaluate associations of RC and Lp-PLA2 with composite adverse events.

RESULTS

Of the 1864 eligible participants, the average age was 60.6 years, and 74.3% were male. Over a follow-up of 12 years, we identified 500 composite adverse events, including 210 major adverse cardiovascular events and 342 all-cause deaths. When compared with the group of low-RC/Lp-PLA2-, the hazard ratios with 95% confidence intervals in the group of high-RC/Lp-PLA2+ for stroke, myocardial infarction, major adverse cardiovascular event, all-cause death and composite endpoints were 1.37 (0.87-2.16), 0.72 (0.28-1.82), 1.29 (0.85-1.95), 1.61 (1.10-2.38) and 1.43 (1.07-1.91), respectively. A significant interaction between RC and Lp-PLA2 status has been found for all-cause death and composite endpoint (p for interaction <0.05). In addition, joint association of RC and Lp-PLA2 with all-cause death was modified by sex and age of <60 versus ≥60 years (p for interaction: 0.035 and 0.01, respectively).

CONCLUSIONS

Elevated RC and Lp-PLA2 levels were associated with an increased risk of composite adverse events, with these associations significantly influenced by sex and age. Our study highlights the synergistic effect of RC and Lp-PLA2 on the composite adverse events.

High remnant cholesterol and atherosclerotic cardiovascular disease in healthy women and men ages 70-100

AIMS

High remnant cholesterol has been increasingly recognized as an important risk factor for atherosclerotic cardiovascular disease (ASCVD). However, uncertainty remains regarding this association in old age. The aim of this study was to test the hypothesis that higher remnant cholesterol is associated with higher incidence of ASCVD in healthy women and men aged 70-100.

METHODS

90,875 women (57%) and men aged 20-100 and without ASCVD, diabetes, or lipid-lowering therapy at baseline were included in the Copenhagen General Population Study in 2003-2015. During a median follow-up of 12.8 years, 7,352 were diagnosed with ASCVD. Incidence rates and hazard ratios were calculated according to age and sex.

RESULTS

The highest incidence rate of ASCVD was observed in individuals aged 70-100 with a remnant cholesterol level >1.0 mmol/L (>39 mg/dL) (23 per 1000 person-years; 95% confidence interval [CI]: 21-25). Likewise, incidence rates of ASCVD per 1.0 mmol/L (39 mg/dL) higher remnant cholesterol were highest in individuals aged 70-100. Multivariable adjusted hazard ratio for 1.0 mmol/L (39 mg/dL) higher remnant cholesterol was 1.31 (95% CI: 1.20-1.44) in those aged 70-100, which was comparable to hazard ratios in younger age groups. Similar relationships were observed for women and men separately.

CONCLUSION

Higher remnant cholesterol was associated with higher incidence of ASCVD in those aged 70-100. The present results suggest that while relative rates of ASCVD for high versus low remnant cholesterol do not increase with higher age, elevated remnant cholesterol contribute substantially to the absolute risk of ASCVD at age 70-100.

Remnant cholesterol and risk of major adverse cardiovascular events: a systematic review and dose-response meta-analysis of cohort studies

Emerging evidence indicates a significant role of remnant cholesterol in contributing to the residual risk associated with major adverse cardiovascular events (MACE). This study aims to evaluate the dose-response relationship between remnant cholesterol and the risk of MACE. PubMed, Embase and Cochrane databases were reviewed to identify cohort studies published in English up to 1 August 2023. Twenty-eight articles were selected. Pooled hazard ratios (HR) and their 95% confidence intervals (CIs) were calculated using fixed or random-effects models to evaluate the association between remnant cholesterol and the risk of MACE. The dose-response relationship between remnant cholesterol levels and the risk of MACE was analyzed using the linear model and restricted cubic spline regression models. For calculated remnant cholesterol levels, the pooled HR (95% CI) of MACE for per 1-SD increase was 1.13 (1.08, 1.17); HR (95% CI) for the second quartile (Q2), the third quartile (Q3) and the highest quartile (Q4) of remnant cholesterol levels were 1.14 (1.03, 1.25), 1.43 (1.23, 1.68) and 1.68 (1.44, 1.97), respectively, compared with the lowest quartile (Q1). For measured remnant cholesterol levels, the pooled HR (95% CI) of MACE per 1-SD increase was 1.67 (1.39, 2.01). The dose-response meta-analysis showed a dose-response relationship between remnant cholesterol levels and the risk of MACE, both on a linear trend (P < 0.0001) and a nonlinear trend (P < 0.0001). The risk of MACE is associated with increased levels of remnant cholesterol, and the dose-response relationship between remnant cholesterol levels and the risk of MACE showed both linear and nonlinear trends.

The effect of lipid-lowering therapy on lipid-related residual risk factors: a prospective study

BACKGROUND

Remnant cholesterol (RC) and nonhigh-density lipoprotein cholesterol (nonHDL-C) are key risk factors for atherosclerotic cardiovascular disease (ASCVD), with apolipoprotein B (apoB) and lipoprotein(a) [Lp(a)] also contributing to its residual risk. However, real-world population-based evidence regarding the impact of current clinical LDL-C-centric lipid-lowering therapy (LLT) on achieving RC and nonHDL-C goals, as well as on modifying residual CVD risk factors is limited.

METHODS

This prospective observational study enrolled 897 CVD patients from September, 2020 to July, 2021. All participants had previously received low-/moderate-intensity LLT and were discharged with either low-/moderate-intensity LLT or high-intensity LLT. After a median follow-up of 3 months, changes in RC, nonHDL-C, and other biomarkers were assessed. Multivariate logistic regression was performed to analyze the impact of the LLT on goal attainment.

RESULTS

Among all patients, 83.50% transitioned to high-intensity LLT from low or moderate. After follow-up, the high-intensity group saw significantly greater reductions in RC (-20.51% vs. -3.90%, P = 0.025), nonHDL-C (-25.12% vs. 0.00%, P < 0.001), apoB (-19.35% vs. -3.17%, P < 0.001), triglycerides (-17.82% vs. -6.62%, P < 0.001), and LDL-C and total cholesterol. Spearman correlation analysis revealed that LDL-C reduction from current LLT was strongly correlated with nonHDL-C reduction (r = 0.87, P < 0.001). Patients who received high-intensity LLT had significant improvements in attainment of RC (from 44.2% to 60.7%, χ² = 39.23, P < 0.001) and nonHDL-C (from 19.4% to 56.9%, χ² = 226.06, P < 0.001) goals. Furthermore, multivariate logistic regression showed that high-intensity LLT was a protective factor for RC [odds ratio (OR) = 0.66; 95% confidence intervals (CI), 0.45-0.97; P = 0.033] and nonHDL-C goal attainment (OR = 0.51; 95% CI, 0.34-0.75; P < 0.001), without a significant increase of adverse reactions.

CONCLUSION

Current levels of clinically prescribed LDL-C-centric treatment can reduce RC and other lipid-related residual risk factors, but high-intensity LLT is better at achieving nonHDL-C and RC goals than low-/moderate-intensity LLT, with a good safety profile. More targeted RC treatments are still needed to reduce residual lipid risk further.

Prognostic value of remnant cholesterol in patients with coronary heart disease: A systematic review and meta-analysis of cohort studies

Background

The relationship between abnormal lipid levels and atherosclerotic cardiovascular diseases is well established, but the association between remnant cholesterol (RC) and coronary heart disease (CHD) remains uncertain. The aim of this meta-analysis is to systematically evaluate the prognostic value of RC concentration in patients with CHD.

Methods

PubMed, EMBASE, Cochrane, and Web of Science databases were reviewed to identify relevant observational cohort studies published in English up to December 2021. Random-effects meta-analysis compared the highest and lowest RC concentration. The primary outcome was a composite of major adverse cardiovascular events (MACEs) and all-cause mortality in patients with CHD.

Results

A total of 10 studies recruiting 30,605 patients with CHD were selected to be included in this meta-analysis. Patients with CHD with elevated RC concentration had an increased risk of the composite endpoint events (RR = 1.54, 95% CI: 1.26-1.87) and MACEs (RR = 1.70, 95% CI: 1.54-1.88), but the risk of all-cause mortality was not statistically significant (RR = 1.16, 95% CI: 0.79-1.69, P = 0.44). Subgroup analysis showed consistent results.

Conclusion

Our results suggest that elevated concentration RC may independently predict MACEs in patients with CHD. Determination of RC concentration may improve risk stratification of prognosis in patients with CHD. However, more high-quality studies are necessary to confirm this association.

Mathematical Analysis of the Healthcare Treatment of 215 Patients with Coronary Heart Disease

The main risk factors for CHD and the comorbidity include hyperlipidemia (HL), hypertension, smoking, dietary factors, and genetic factors. In this work, 215 patients with coronary heart disease, including 128 males and 87 females, were analyzed for a better understanding of the related clinical pharmacology. Nonparametric test, analysis of variance, chi-square test, correlation analysis, and other methods were used to sort out the data. From the analysis, there are significant differences in age among different gender samples. The incidence of coronary heart disease in men is five years younger than that in women. The sample pairs from different regions showed differences in the presence of family history of diabetes, indicating that a series of patients in some regions concentrated on the disease status of family history of diabetes. Age has a significant positive effect on cardiac functional classification. The older you are, the larger the cardiac functional classification is and the worse the cardiac function is. Age was negatively correlated with VTE score, diastolic blood pressure, CAR, TG, neutrophil, and TC. The older you are, the lower these six values are. Samples of different types of CHD showed significant differences in the presence of comorbidity and family history of CHD. The most significant are unstable angina pectoris and ischemic cardiomyopathy. Samples of different CHD types showed significant effects on VTE score, creatine kinase, low-density lipoprotein cholesterol (LDL⁃C), and lactate dehydrogenase. The highest lactate dehydrogenase is ischemic cardiomyopathy. The highest LDL cholesterol is ST-segment elevation angina. The highest creatine kinase is ischemic cardiomyopathy. The VTE score was the highest for ischemic cardiomyopathy, followed by non-ST-segment elevation angina. Samples taken with or without lipid-lowering drugs showed significant differences in lactate dehydrogenase, creatinine, and TC. There was a significant positive correlation between VTE scores and lactate dehydrogenase, myoglobin, and creatine kinase. High VTE score indicates high lactate dehydrogenase, myoglobin, and creatine kinase. TC has a significant positive correlation with HDL⁃C and TG, respectively. Higher TC values indicate higher HDL⁃C and TG values.