Association between remnant cholesterol and colorectal cancer risk in Korea: a nationwide population-based study

Background/Aims: Remnant cholesterol (RC) has emerged as a novel lipid marker with potential implications in cardiovascular and metabolic diseases. However, its association with colorectal cancer (CRC) remains unclear.Methods: We conducted a retrospective cohort study using data from 364,626 Korean adults who underwent a national health screening between 2012 and 2013. RC and other lipid parameters were categorized into quartiles. Participants were followed up until CRC diagnosis, death, or December 31, 2019. Cox proportional hazards models were used to estimate the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) after controlling for demographic, clinical, and lifestyle factors.Results: CRC incidence increased from 1.75 to 2.25 per 1,000 person-years across the RC quartiles. When compared with Q1, adjusted HRs were 1.08 (95% CI, 0.96–1.21) in Q2, 1.13 (1.01–1.26) in Q3, and 1.21 (1.08–1.35) in Q4. A similar trend was observed for triglycerides but not for low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, or total cholesterol. In the subgroup analyses, the association between RC and CRC was stronger in participants aged ≥ 65 years and those with a body mass index < 23 kg/m2.Conclusions: Elevated RC levels were independently associated with an increased risk of CRC. Thus, RC may serve as a useful biomarker for CRC risk stratification beyond traditional lipid parameters.