LONGITUDINAL CHANGES IN REMNANT CHOLESTEROL AND INCIDENT CARDIOVASCULAR DISEASE

Objective: Remnant cholesterol (RC) has been recognized as a modifiable risk factor for cardiovascular disease (CVD). However, the association between long-term changes in RC during follow-up and incident CVD remains underexplored, with most research focusing on baseline RC levels. Design and method: Data for this prospective cohort study were derived from the China Health and Retirement Longitudinal Study (CHARLS). RC levels were calculated using the Friedewald equation. Changes in RC, cumulative RC, and the change in RC (δRC) were assessed by comparing RC levels at Waves 1 and 3. Multivariate Cox proportional hazard models, adjusted for potential confounders, were used to evaluate the impact of baseline and dynamic RC levels on risks of incident CVD. Results: A total of 3,866 participants from CHARLS (46.23% male, mean age: 57.50 years) met the inclusion and exclusion criteria, with a median follow-up period of 5.0 years. After comprehensive adjusting for confounders, participants with low baseline RC who escalated to high RC levels by Wave 3 exhibited comparable incident CVD risks (hazard ratio [HR] 0.84, 95% confidence interval [CI] 0.67-1.05) when contrasted with those who maintained consistently high RC levels. Conversely, participants with high baseline RC decreased to low RC levels at Wave 3 exhibited reduced risks of incident CVD (HR 0.67, 95% CI 0.50-0.89) compared to those with consistently high RC levels. Participants in the highest tertile of cumulative RC had significantly increased risks of incident CVD (HR 1.37, 95% CI 1.11–1.69), and those in the middle tertile also demonstrated elevated risks (HR 1.29, 95% CI 1.05–1.59). Additionally, among participants with high baseline levels of RC, those in the lowest tertile of δRC experienced a reduction in risks of incident CVD (HR 0.68, 95% CI 0.52–0.89), with a similar trend was observed for those in the middle tertile of δRC (HR 0.77, 95% CI 0.60–1.00). Conclusions: Variations in RC levels over time are associated with differing risks of incident CVD. A longitudinal increase in RC is linked to higher CVD risks, while a reduction in RC is associated with decreased risks of CVD.