Frontiers in nutrition · 2026
Remnant cholesterol, C-reactive protein, cholesterol-lowering medication, and cardiovascular outcome: novel findings from UK Biobank.
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Chen Jing, Song Xuan, Li Jian-Jun, Tao Li-Chan
Аннотация
BACKGROUND: Despite substantial reductions in cardiovascular events with intensive LDL-C lowering, significant residual risk persists. Remnant cholesterol (RC) and C-reactive protein (CRP) reflect lipid dysregulation and inflammation, respectively, and may synergistically promote atherosclerosis. However, large-scale cohort evidence on their combined impact, particularly the quantitative interaction between the two and the modifying role of cholesterol-lowering therapy, remains limited.
METHODS: This study included 376,817 participants with a median follow-up of 13.4 years. Cox proportional hazards regression models were used to evaluate the individual and joint associations of RC and CRP with major adverse cardiovascular events (MACE) risk. Stratified analyses by cholesterol-lowering therapy were further conducted to explore its modifying effect on the combined risk.
RESULTS: Both RC (≥0.8 mmol/L) and CRP (≥2 mg/L) were independently associated with MACE risk, with adjusted hazard ratios (HR) of 1.074 [95% confidence interval (CI): 1.024-1.126] and 1.168 (95% CI: 1.129-1.207), respectively. Concurrent elevation of both biomarkers conferred the highest risk (HR = 1.239, 95% CI: 1.167-1.316), and a significant positive multiplicative interaction was observed between RC and CRP. Stratified analyses suggested effect modification by cholesterol-lowering medication: the association between isolated RC elevation and MACE was attenuated in medication users, whereas risks remained significant for isolated CRP elevation and combined elevation of both markers.
CONCLUSION: Concurrent elevation of RC and CRP yields the highest MACE risk with a positive additive interaction. Cholesterol-lowering therapy reduces RC-related risk but not inflammation-driven risk in isolated CRP elevation. These findings support combined assessment of both biomarkers for personalized cardiovascular risk stratification.
METHODS: This study included 376,817 participants with a median follow-up of 13.4 years. Cox proportional hazards regression models were used to evaluate the individual and joint associations of RC and CRP with major adverse cardiovascular events (MACE) risk. Stratified analyses by cholesterol-lowering therapy were further conducted to explore its modifying effect on the combined risk.
RESULTS: Both RC (≥0.8 mmol/L) and CRP (≥2 mg/L) were independently associated with MACE risk, with adjusted hazard ratios (HR) of 1.074 [95% confidence interval (CI): 1.024-1.126] and 1.168 (95% CI: 1.129-1.207), respectively. Concurrent elevation of both biomarkers conferred the highest risk (HR = 1.239, 95% CI: 1.167-1.316), and a significant positive multiplicative interaction was observed between RC and CRP. Stratified analyses suggested effect modification by cholesterol-lowering medication: the association between isolated RC elevation and MACE was attenuated in medication users, whereas risks remained significant for isolated CRP elevation and combined elevation of both markers.
CONCLUSION: Concurrent elevation of RC and CRP yields the highest MACE risk with a positive additive interaction. Cholesterol-lowering therapy reduces RC-related risk but not inflammation-driven risk in isolated CRP elevation. These findings support combined assessment of both biomarkers for personalized cardiovascular risk stratification.