Atherosclerosis · 2026
Non-HDL cholesterol and remnant cholesterol are better indicators of atherosclerotic cardiovascular disease risk than LDL cholesterol in patients with chronic kidney disease.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Li Man, Gu Wan-Jie, Cao Liu-Liu, Chen Shuo-Hua, Duan Xiang-Jie, Xu Yu-Hao, Wu Shou-Ling, Yin Hai-Yan
Аннотация
BACKGROUND AND AIMS: Low-density lipoprotein cholesterol (LDL-C) is the primary therapeutic target for lipid lowering, yet it may incompletely reflect atherosclerotic cardiovascular disease (ASCVD) risk in patients with chronic kidney disease (CKD). Non-high-density lipoprotein cholesterol (non-HDL-C) and remnant cholesterol (RC) capture cholesterol carried by a broader spectrum of atherogenic lipoproteins and may provide complementary information for risk stratification in this population. This study aimed to compare the associations of LDL-C, non-HDL-C, and RC with ASCVD risk and to evaluate their performance in discordant lipid profiles among patients with CKD.
METHODS: A total of 27,978 CKD patients from the Kailuan cohort were included, with a median follow-up of 13.81 years. Associations of LDL-C, non-HDL-C, and RC with incident ASCVD were assessed using Cox proportional hazards models and restricted cubic spline analyses. Discordance analyses were conducted using clinically relevant lipid cutoffs.
RESULTS: Higher levels of LDL-C, non-HDL-C, and RC were all associated with an increased risk of ASCVD. However, the associations of non-HDL-C and RC with ASCVD risk were more consistent across subgroups, whereas those for LDL-C were more heterogeneous. Compared with participants with concordantly low lipid levels, those with elevated non-HDL-C or RC but normal LDL-C had significantly higher ASCVD risk.
CONCLUSIONS: In patients with CKD, non-HDL-C and RC were more consistently associated with ASCVD risk than LDL-C. Discordance analyses suggest that these lipid parameters may improve residual ASCVD risk stratification beyond LDL-C-based assessment.
METHODS: A total of 27,978 CKD patients from the Kailuan cohort were included, with a median follow-up of 13.81 years. Associations of LDL-C, non-HDL-C, and RC with incident ASCVD were assessed using Cox proportional hazards models and restricted cubic spline analyses. Discordance analyses were conducted using clinically relevant lipid cutoffs.
RESULTS: Higher levels of LDL-C, non-HDL-C, and RC were all associated with an increased risk of ASCVD. However, the associations of non-HDL-C and RC with ASCVD risk were more consistent across subgroups, whereas those for LDL-C were more heterogeneous. Compared with participants with concordantly low lipid levels, those with elevated non-HDL-C or RC but normal LDL-C had significantly higher ASCVD risk.
CONCLUSIONS: In patients with CKD, non-HDL-C and RC were more consistently associated with ASCVD risk than LDL-C. Discordance analyses suggest that these lipid parameters may improve residual ASCVD risk stratification beyond LDL-C-based assessment.