Nutrition, Metabolism and Cardiovascular Diseases
Remnant cholesterol as a risk factor for cardiovascular, cancer or other causes mortality: A competing risks analysis
Graphical abstract
Section snippets
Methods
Details about study populations have been published elsewhere [[25], [26], [27]]. Briefly, two different prospective cohort studies conducted by the Laboratory of Epidemiology and Biostatistics of the National Institute of Gastroenterology, “Saverio de Bellis” Research Hospital (Castellana Grotte, Bari, Italy) were included. The MICOL Study [28] is a random sample study drawn from the electoral list of Castellana Grotte (≥30 years old) in 1985 and followed up in 1992, 2005–2006 and 2013–2016.
Baseline and follow-up characteristics
The study population included 5729 subjects from the MICOL II/Panel Study (3428) plus NUTRIHEP (2301). This study-base generated 86,049.99 person-years of observation. Median follow-up was 11.80 (IQR 10.75–28.58) years.
At the end of follow-up, 4868 subjects (84.9%) were alive/censored, whereas 861 (15.1%) had died. Causes of death were: 234 CVDs (27.2%), 245 CDs (28.5%) and 271 OCDs (31.5%). It was not possible to trace the cause of death (death certificate not found) for 111 subjects (12.8%).
Discussion
This competitive risk analysis investigated and quantified the effect of RC on cause-specific mortality. RC is a strong risk factor for CVDs. The estimates have been adjusted for several confounding factors to obtain more valid and precise measures. The novel aspect of this study is the competing risks survival analysis performed to estimate the risk and rate of RC on CVDs, CDs, and OCDs and the setting of study (general population).
Scientific evidence about the association between RC and
Funding
This work was supported by: MICOL II: This research was supported by a grant from the Ministry of Health, Italy (Progetto Finalizzato Ministero della Sanita Numero 11 Gazzetta Ufficiale Nr. 263 (Serie Generale), de1 7-X1-92). MICOL III: This research was supported by a grant from the Ministry of Health, Italy (Progetto Finalizzato del Ministero della Salute, ICS 160.2/RF 2003), 2004/2006). MICOL IV: This research was supported by a grant from the Ministry of Health, Italy (Ricerca Corrente DDG
Declaration of Competing Interest
None declared.
References (61)
- et al.
Genetic inhibition of CETP, ischemic vascular disease and mortality, and possible adverse effects
J Am Coll Cardiol
(2012) - et al.
Remnant cholesterol as a causal risk factor for ischemic heart disease
J Am Coll Cardiol
(2013) - et al.
Remnant cholesterol as a cause of ischemic heart disease: evidence, definition, measurement, atherogenicity, high risk patients, and present and future treatment
Pharmacol Ther
(2014) - et al.
Relation of fasting triglyceride-rich lipoprotein cholesterol to coronary artery calcium score (from the ELSA-Brasil study)
Am J Cardiol
(2017) - et al.
Factors associated with gallstone disease in the MICOL experience. Multicenter Italian Study on Epidemiology of Cholelithiasis
Hepatology
(1997) - et al.
Triglycerides and cardiovascular disease
Lancet
(2014) - et al.
Hepatic lipase mutations, elevated high-density lipoprotein cholesterol, and increased risk of ischemic heart disease: the Copenhagen City Heart Study
J Am Coll Cardiol
(2003) - et al.
Plasma HDL cholesterol and risk of myocardial infarction: a mendelian randomisation study
Lancet
(2012) - et al.
Smoldering and polarized inflammation in the initiation and promotion of malignant disease
Cancer Cell
(2005) - et al.
High density lipoprotein cholesterol and cancer: marker or causative?
Prog Lipid Res
(2018)
Temporal trends in ischemic heart disease mortality in 21 world regions, 1980 to 2010: the Global Burden of Disease 2010 study
Circulation
Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for management
Eur Heart J
From lipids to inflammation: new approaches to reducing atherosclerotic risk
Circ Res
Nonfasting Cholesterol and triglycerides and association with risk of myocardial infarction and total mortality: the Copenhagen City Heart Study with 31 years of follow-up
J Intern Med
Triglyceride-rich lipoproteins and atherosclerotic cardiovascular disease: new insights from epidemiology, genetics, and biology
Circ Res
Remnant cholesterol, low-density lipoprotein cholesterol, and blood pressure as mediators from obesity to ischemic heart disease
Circ Res
Elevated remnant cholesterol causes both low-grade inflammation and ischemic heart disease, whereas elevated low-density lipoprotein cholesterol causes ischemic heart disease without inflammation
Circulation
Extreme nonfasting remnant cholesterol vs. extreme LDL cholesterol as contributors to cardiovascular disease and all-cause mortality in 90000 individuals from the general population
Clin Chem
Variants with large effects on blood lipids and the role of cholesterol and triglycerides in coronary disease
Nat Genet
Predictive value of nonfasting remnant cholesterol for short-term outcome of diabetics with new-onset stable coronary artery disease
Lipids Health Dis
Non-HDL cholesterol and triglycerides: implications for coronary atheroma progression and clinical events
Arterioscler Thromb Vasc Biol
Inflammation and cancer
Nature
Molecular pathways: adipose inflammation as a mediator of obesity-associated cancer
Clin Cancer Res
Remnant lipoproteins
Curr Opin Lipidol
Genetically elevated nonfasting triglycerides and calculated remnant cholesterol as causal risk factors for myocardial infarction
Eur Heart J
Competing risks and the clinical community: irrelevance or ignorance?
Stat Med
Competing risk regression models for epidemiologic data
Am J Epidemiol
Introduction to the analysis of survival data in the presence of competing risks
Circulation
Direct likelihood inference on the cause-specific cumulative incidence function: a flexible parametric regression modelling approach
Stat Med
stpm2cr: a flexible parametric competing risks model using a direct likelihood approach for the cause-specific cumulative incidence function
STATA J
Cited by (10)
Remnant cholesterol in atherosclerotic cardiovascular disease: A systematic review and meta-analysis
2023, Hellenic Journal of CardiologyElevated remnant cholesterol increase 6-year type 2 diabetes mellitus onset risk
2023, Clinica Chimica ActaElevated Serum Concentrations of Remnant Cholesterol Associate with Increased Carotid Intima-Media Thickness in Children and Adolescents
2021, Journal of PediatricsCitation Excerpt :Insulin resistance was determined by a homeostasis model assessment of insulin resistance (HOMA-IR). As previously proposed,12,20,21 fasting remnant cholesterol was calculated as total cholesterol minus HDL-C minus LDL-C and expressed as mg/dL. Hepatic and carotid ultrasonography were performed in all patients by a single experienced radiologist who was blinded to the participants’ details.
Prognostic value of remnant cholesterol in patients with coronary heart disease: A systematic review and meta-analysis of cohort studies
2023, Frontiers in Cardiovascular Medicine
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These authors equally contributed to this work.