ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Lipids in Cardiovascular Disease
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1503705
Relationship between Dynamic changes in Remnant Cholesterol and Cardiovascular Disease in Middle-aged and Older Chinese: A National Cohort Study
Provisionally accepted
- 1Taiyuan Central Hospital, Taiyuan, China
- 2Zhongshan Hospital, Fudan University, Shanghai, Shanghai Municipality, China
- 3Changzhi Medical College, Changzhi, Shanxi Province, China
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Aim: Epidemiological and genetic studies have shown that elevated basal remnant cholesterol (RC) levels increase cardiovascular disease (CVD) risk. However, the relationship between RC dynamics and CVD remains unclear. We aimed to investigate the relationship between the dynamic changes in RC and CVD occurrence in middleaged and elderly populations in China.This cohort study investigated data from the study population of the 2011 and 2015 China Health and Retirement Longitudinal Study (CHARLS) and included 4431 participants aged ≥ 45 years who provided complete information on RC and the occurrence or absence of CVD. Based on the change in RC in the population from 2011-2015, this study categorized the population into clusters 1, 2, and 3 using kmeans cluster analysis. The relationship between baseline RC and CVD risk was examined using receiver operating characteristic (ROC) curves and restricted cubic spline (RCS) analysis. Logistic regression was used to explore the association between dynamic changes in RC levels and CVD risk, and subgroup analyses and sensitivity analyses were performed. There were 132 new cases of CVD among the 4431 participants (2386 women [53.85%] and 2045 men [46.15%]; follow-up time, 4 years).The area under the ROC curve for baseline RC in CVD was 0.534. RCS regression showed a linear association between RC at baseline and CVD. Logistic regression results showed a significantly increased CVD risk in Cluster 3 compared with Cluster 1 after correction for confounders (OR=1.69, 95%CI: 1.13-2.55, P=0.012); similarly, the risk of heart disease was significantly increased in Cluster 3 (OR=1.76, 95%CI:1.13-2.76, P=0.012). Subgroup analyses showed a higher CVD risk in participants with baseline renal disease (OR=15.34, 95%CI: 1.2-195.35, P=0.035) and an interaction between RC change and body mass index (P for interaction=0.038). Age-stratified analysis revealed a small difference in baseline RC between age groups (difference = -1.01 mg/dL, 95% CI: 0.08 to 1.94, P = 0.0328). RC showed the strongest correlation observed with TG (r = 0.80, p < 0.001).In middle-aged and older Chinese participants, increased dynamic RC predicts increased CVD risk. Therefore, continuous monitoring of changes in RC levels is needed to reduce the risk of CVD.
Keywords: Dynamic changes, Remnant cholesterol, cardiovascular disease, middle-aged and older Chinese adults, National cohort study
Received: 29 Sep 2024; Accepted: 03 Jun 2025.
Copyright: © 2025 Zhang, Ma, Pei, Ren and Qiu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jin Qiu, Taiyuan Central Hospital, Taiyuan, China
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