Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (S.Q., T.X., C.Z.).
Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China (S.Y., C.L., Y.C.).
Circ Cardiovasc Imaging. 2021 Apr;14(4):e010953. doi: 10.1161/CIRCIMAGING.120.010953. Epub 2021 Apr 9.
Remnant cholesterol makes great contribution to residual risk of cardiovascular disease, but population-based evidence on the relationship between remnant cholesterol and atherosclerosis is rare. Common carotid artery intima-media thickness (cIMT) is an imaging marker of subclinical atherosclerosis. We aimed to explore the association between remnant cholesterol levels and cIMT in patients with ischemic stroke.
One thousand four hundred ninety-six ischemic stroke patients with baseline serum lipids and carotid artery imaging data were included in this analysis. Fasting remnant cholesterol was calculated as total cholesterol minus HDL (high-density lipoprotein) cholesterol minus LDL (low-density lipoprotein) cholesterol. Abnormal cIMT was defined as mean cIMT and maximum cIMT value ≥1 mm. Logistic regression and restricted cubic spline models were used to assess the relationships between remnant cholesterol levels and abnormal cIMT.
The multivariable-adjusted odds ratios (95% CIs) for the highest versus lowest quartile of remnant cholesterol were 2.06 (1.46-2.91) for abnormal mean cIMT and 1.70 (1.23-2.35) for abnormal maximum cIMT. There were linear associations between remnant cholesterol levels and both abnormal mean cIMT ( for linearity, <0.001) and abnormal maximum cIMT ( for linearity, 0.003). Moreover, the remnant cholesterol-cIMT association remained significant in the subsample of patients with optimal LDL cholesterol levels (n=179).
Elevated fasting remnant cholesterol levels were positively associated with mean cIMT and maximum cIMT in patients with ischemic stroke, even in patients with optimal LDL cholesterol levels. Future prospective studies are needed to verify our findings and to assess the effect of remnant cholesterol-lowering interventions in patients with ischemic stroke.
残余胆固醇对心血管疾病的残余风险有很大贡献，但基于人群的残余胆固醇与动脉粥样硬化之间关系的证据很少。颈总动脉内膜-中层厚度（cIMT）是亚临床动脉粥样硬化的影像学标志物。我们旨在探讨缺血性脑卒中患者残余胆固醇水平与 cIMT 之间的关系。
本分析纳入了 1496 例基线血脂和颈动脉影像学数据的缺血性脑卒中患者。空腹残余胆固醇定义为总胆固醇减去高密度脂蛋白（HDL）胆固醇减去低密度脂蛋白（LDL）胆固醇。异常 cIMT 定义为平均 cIMT 和最大 cIMT 值≥1mm。使用逻辑回归和限制立方样条模型评估残余胆固醇水平与异常 cIMT 之间的关系。
最高四分位残余胆固醇与最低四分位残余胆固醇相比，异常平均 cIMT 的多变量调整比值比（95%CI）为 2.06（1.46-2.91），异常最大 cIMT 的比值比为 1.70（1.23-2.35）。残余胆固醇水平与异常平均 cIMT（线性趋势，<0.001）和异常最大 cIMT（线性趋势，0.003）之间存在线性关联。此外，在 LDL 胆固醇水平最佳的患者亚组（n=179）中，残余胆固醇与 cIMT 的关联仍然显著。
空腹残余胆固醇水平升高与缺血性脑卒中患者的平均 cIMT 和最大 cIMT 呈正相关，即使在 LDL 胆固醇水平最佳的患者中也是如此。需要进一步的前瞻性研究来验证我们的发现，并评估降低残余胆固醇干预在缺血性脑卒中患者中的效果。
