Two-Point Change Patterns of LDL-Cholesterol and hs-CRP and Risk of Major Adverse Cardiovascular Events in Middle-Aged and Older Chinese Adults: A Prospective Cohort Study.

BACKGROUND AND AIMS: The associations of two-point change patterns of low-density lipoprotein cholesterol (LDL-C) and high-sensitivity C-reactive protein (hs-CRP) with major adverse cardiovascular events (MACE) remain underexplored, particularly in Chinese populations. This study aimed to identify LDL-C and hs-CRP change patterns and examine their associations with incident MACE in middle-aged and older Chinese adults.

METHODS

This prospective cohort study included 9597 participants aged 45 years or older and free of cardiovascular disease at baseline from the China Health and Retirement Longitudinal Study. Among them, 6405 participants with biomarker measurements available in both 2011 and 2015 were included in the two-point change pattern analysis. Group-based trajectory modeling was used to identify two-point change pattern groups for LDL-C and log-transformed hs-CRP. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), with adjustment for potential confounders including lipid-lowering medication use.

RESULTS

Over a median follow-up of 9.00 years, 2248 participants (23.4%) developed MACE. Higher baseline hs-CRP levels were associated with increased MACE risk, with a significant association observed for the fourth quintile versus the first quintile (HR = 1.19, 95% CI: 1.04-1.36). In the two-point change pattern analysis, the High baseline, decreasing log-hsCRP group showed a lower HR estimate for MACE than the Low baseline, increasing group, although this association did not reach conventional statistical significance (HR = 0.82, 95% CI: 0.67-1.01, p = 0.06). Neither baseline LDL-C levels nor LDL-C two-point change pattern groups were significantly associated with MACE after full multivariable adjustment. Having one elevated biomarker (LDL-C Q5 or hs-CRP Q5) was associated with increased MACE risk (HR = 1.11, 95% CI: 1.02-1.21) compared with having neither elevated.

CONCLUSION

Baseline hs-CRP showed a stronger association with MACE than LDL-C after comprehensive adjustment. A decrease in hs-CRP from a high baseline level was associated with a lower HR estimate for MACE, although this finding was not statistically significant. These results support the relevance of inflammatory status in cardiovascular risk assessment, while LDL-C monitoring remains a cornerstone of cardiovascular prevention.