Discordant High Remnant Cholesterol With LDL-C Increases the Risk of Stroke: A Chinese Prospective Cohort Study-Reference-Cited by-同舟云学术

Discordant High Remnant Cholesterol With LDL-C Increases the Risk of Stroke: A Chinese Prospective Cohort Study

Published:2024-08 Issue:8 Volume:55 Page:2066-2074
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

Han Minghui¹²³,Huang Keyong²³,Shen Chong¹⁴^ORCID,Hu Hongyue¹²³,Liu Fangchao²³^ORCID,Li Jianxin²³^ORCID,Yang Xueli⁵,Chen Jichun²³^ORCID,Liu Xiaoqing⁶,Cao Jie²³,Chen Shufeng²³^ORCID,Yu Ling⁷,Zhao Yingxin⁸,Wu Xianping⁹,Zhao Liancheng²³,Li Ying²³,Hu Dongsheng¹⁰¹¹^ORCID,Huang Jianfeng²³^ORCID,Lu Xiangfeng²³^ORCID,Gu Dongfeng¹²³¹²^ORCID

Affiliation:

1. Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, China (M.H., C.S., H.H., D.G.).

2. Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (M.H., K.H., H.H., F.L., J.L., J. Chen, J. Cao, S.C., L.Z., Y.L., J.H., X. Lu, D.G.).

3. Key Laboratory of Cardiovascular Epidemiology (M.H., K.H., H.H., F.L., J.L., J. Chen, J. Cao, S.C., L.Z., Y.L., J.H., X. Lu, D.G.), Chinese Academy of Medical Sciences, Beijing, China.

4. Research Units of Cohort Study on Cardiovascular Diseases and Cancers (C.S.), Chinese Academy of Medical Sciences, Beijing, China.

5. Tianjin Key Laboratory of Environment, Nutrition and Public Health, Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, China (X.Y.).

6. Division of Epidemiology, Guangdong Provincial People’s Hospital and Cardiovascular Institute, Guangzhou, China (X. Liu).

7. Department of Cardiology, Fujian Provincial Hospital, Fuzhou, China (L.Y.).

8. Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (Y.Z.).

9. Sichuan Center for Disease Control and Prevention, Chengdu, China (X.W.).

10. Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, China (D.H.).

11. Department of Epidemiology and Health Statistics, School of Public Health, Shenzhen University Health Science Center, China (D.H.).

12. School of Medicine, Southern University of Science and Technology, Shenzhen, China (D.G.).

Abstract

BACKGROUND: Previous studies focusing on assessing the effects of remnant cholesterol (RC) and low-density lipoprotein cholesterol (LDL-C) on stroke may not consider their mutual influence. We aimed to explore the associations of RC and discordant high RC with LDL-C with stroke, ischemic stroke (IS), and hemorrhagic stroke. METHODS: This prospective cohort study was conducted based on 3 cohorts of the China-PAR (Prediction for Atherosclerotic Cardiovascular Disease Risk in China) project. RC was calculated as non–high-density lipoprotein cholesterol minus LDL-C estimated by Martin/Hopkins equations. Concordant/discordant categories for RC versus LDL-C were determined based on cut-points of 130 mg/dL for LDL-C and equivalent percentile (32.50 mg/dL) for RC. Cox models were used to estimate adjusted hazard ratios and 95% CIs for incident stroke. RESULTS: Among 113 448 participants recruited at baseline, a total of 98 967 participants were eligible for the final analysis (mean age of 51.44 years; 40.45% were men). During 728 776.87 person-years of follow-up, 2859 stroke cases, 1811 IS cases, and 849 hemorrhagic stroke cases were observed. RC was positively associated with stroke and IS, but not hemorrhagic stroke, with adjusted hazard ratios (95% CIs) of 1.06 (1.02–1.10), 1.09 (1.04–1.13), and 0.95 (0.88–1.03) for per SD increase in RC. Compared with low LDL-C/low RC group, low LDL-C/high RC group had higher risks of stroke (adjusted hazard ratio, 1.15 [95% CI, 1.02–1.30]) and IS (1.19, 1.03–1.38), while high LDL-C/low RC group had no increased risk of stroke (1.07 [0.95–1.20]) and IS (1.09 [0.94–1.25]). CONCLUSIONS: Higher RC was associated with increased risks of stroke and IS but not hemorrhagic stroke. Discordantly high RC, not discordantly high LDL-C, conferred higher risks of stroke and IS. Our findings support further lowering RC by interventions to reduce residual IS risk.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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