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ORIGINAL RESEARCH article

Front. Endocrinol.
Sec. Cardiovascular Endocrinology
Volume 15 - 2024 | doi: 10.3389/fendo.2024.1417228
This article is part of the Research Topic TRLs (Triglycerides-Rich Lipoproteins): A New Target for Atherosclerosis View all 4 articles

Remnant cholesterol and all-cause mortality risk: findings from the National Health and Nutrition Examination Survey, 2003-2015

Provisionally accepted
Muhan Bai Muhan Bai 1Jiangquan Liao Jiangquan Liao 2Yan Wang Yan Wang 2Liang Mengqi Liang Mengqi 3*Chuan Wang Chuan Wang 4*Jie Zhang Jie Zhang 2*Mingjing Shao Mingjing Shao 2*
  • 1 Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, China
  • 2 National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China-Japan Friendship Hospital, Beijing, China
  • 3 Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
  • 4 Department of Cardiac Surgery, Beijing Anzhen Hopital, Capital Medical University, Beijing, China

The final, formatted version of the article will be published soon.

    Aims: Cholesterol carried in triglyceride-rich lipoproteins, also called remnant cholesterol, is increasingly acknowledged as an important causal risk factor for atherosclerosis. Elevated remnant cholesterol, marked by elevated plasma triglycerides, is associated causally with an increased risk of atherosclerotic cardiovascular disease. However, the association with all-cause mortality and causespecific mortality is inconclusive. This study aimed to test the hypothesis that remnant cholesterol levels and plasma triglycerides are associated with increased all-cause mortality and mortality from cardiovascular disease, cancer, and other causes. Methods and results: Using a contemporary population-based cohort, 7,962 individuals from the National Health and Nutrition Examination Survey (NHANES) aged over 40 years at baseline in 2003-2015 were included. During up to 109.2 (± 1.44) months of follow-up, 1,323 individuals died: 385 individuals died from cardiovascular disease, 290 from cancer, 80 from cerebrovascular disease, and 568 from other causes.Compared with the middle tertile remnant cholesterol level, multivariable-adjusted mortality hazard ratios were 1.20 (95% confidence interval 1.02-1.40) for all-cause mortality. For the highest tertile remnant cholesterol level, multivariable-adjusted mortality hazard ratios were 1.21 (95% confidence interval 1.05,1.40). Our conclusions remained stable in subgroup analyses. Exploratory analysis of the cause of death subcategories showed corresponding hazard ratios of 1.25 (1.13-1.38) for Noncardiovascular and Non-cerebrovascular Death for lower remnant cholesterol individuals, 1.47 (1.01-2.15) for cancer death for lower remnant cholesterol (RC) individuals, and 1.80 (1.36-2.38) for cancer death for higher RC individuals.RC levels were associated with U-shaped all-cause mortality. RC was associated with mortality from non-cardiovascular, non-cerebrovascular, and cancer, but not from cardiovascular causes. This novel finding should be confirmed in other cohorts.

    Keywords: Remnant cholesterol, All-cause mortality, cardiovascular disease, Cause-specific mortality, NHANES

    Received: 14 Apr 2024; Accepted: 08 Jul 2024.

    Copyright: © 2024 Bai, Liao, Wang, Mengqi, Wang, Zhang and Shao. 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:
    Liang Mengqi, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
    Chuan Wang, Department of Cardiac Surgery, Beijing Anzhen Hopital, Capital Medical University, Beijing, 100029, China
    Jie Zhang, National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China-Japan Friendship Hospital, Beijing, China
    Mingjing Shao, National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China-Japan Friendship Hospital, Beijing, China

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