Department of Clinical Biochemistry, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 73, 2730, Herlev, Denmark; The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 73, 2730, Herlev, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark.
Department of Clinical Biochemistry, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 73, 2730, Herlev, Denmark; The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 73, 2730, Herlev, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark.
Atherosclerosis. 2023 Aug;379:117141. doi: 10.1016/j.atherosclerosis.2023.05.010. Epub 2023 May 13.
Elevated remnant cholesterol and low-grade inflammation each cause atherosclerotic cardiovascular disease (ASCVD); however, it is unknown whether joint elevation of both factors confers the highest risk. We tested the hypothesis that dual elevated remnant cholesterol and low-grade inflammation marked by elevated C-reactive protein is associated with the highest risk of myocardial infarction, ASCVD, and all-cause mortality.
The Copenhagen General Population Study randomly recruited white Danish individuals aged 20-100 years in 2003-2015 and followed them for a median 9.5 years. ASCVD was cardiovascular mortality, myocardial infarction, stroke, and coronary revascularization.
In 103,221 individuals, we observed 2,454 (2.4%) myocardial infarctions, 5,437 (5.3%) ASCVD events, and 10,521 (10.2%) deaths. The hazard ratios increased with each of stepwise higher remnant cholesterol and stepwise higher C-reactive protein. In individuals with the highest tertile of both remnant cholesterol and C-reactive protein compared to individuals with the lowest tertile of both, the multivariable adjusted hazard ratios were 2.2 (95%CI:1.9-2.7) for myocardial infarction, 1.9 (1.7-2.2) for ASCVD, and 1.4 (1.3-1.5) for all-cause mortality. Corresponding values for only the highest tertile of remnant cholesterol were 1.6 (1.5-1.8), 1.4 (1.3-1.5), and 1.1 (1.0-1.1), and those for only the highest tertile of C-reactive protein were 1.7 (1.5-1.8), 1.6 (1.5-1.7), and 1.3 (1.3-1.4), respectively. There was no statistical evidence for interaction between elevated remnant cholesterol and elevated C-reactive protein on risk of myocardial infarction (p = 0.10), ASCVD (p = 0.40), or all-cause mortality (p = 0.74).
Dual elevated remnant cholesterol and C-reactive protein confers the highest risk of myocardial infarction, ASCVD, and all-cause mortality, that is, compared to either of these two factors individually.
升高的残余胆固醇和低度炎症均会导致动脉粥样硬化性心血管疾病（ASCVD）；然而，目前尚不清楚同时升高这两个因素是否会带来最高的风险。我们检验了这样一个假设，即同时升高残余胆固醇和 C 反应蛋白所标志的低度炎症与心肌梗死、ASCVD 和全因死亡率的风险最高有关。
哥本哈根普通人群研究于 2003-2015 年随机招募了 20-100 岁的丹麦白人个体，并对他们进行了中位 9.5 年的随访。ASCVD 是心血管死亡率、心肌梗死、卒中和冠状动脉血运重建。
在 103221 名个体中，我们观察到 2454 例（2.4%）心肌梗死、5437 例（5.3%）ASCVD 事件和 10521 例（10.2%）死亡。风险比随着残余胆固醇和 C 反应蛋白水平的逐步升高而增加。与残余胆固醇和 C 反应蛋白最低三分位数的个体相比，残余胆固醇和 C 反应蛋白最高三分位数的个体多变量校正后的风险比分别为 2.2（95%CI：1.9-2.7）的心肌梗死、1.9（1.7-2.2）的 ASCVD 和 1.4（1.3-1.5）的全因死亡率。仅残余胆固醇最高三分位数的相应值为 1.6（1.5-1.8）、1.4（1.3-1.5）和 1.1（1.0-1.1），仅 C 反应蛋白最高三分位数的相应值为 1.7（1.5-1.8）、1.6（1.5-1.7）和 1.3（1.3-1.4）。升高的残余胆固醇和 C 反应蛋白之间在心肌梗死（p=0.10）、ASCVD（p=0.40）或全因死亡率（p=0.74）的风险上没有统计学意义的交互作用。
同时升高残余胆固醇和 C 反应蛋白会导致心肌梗死、ASCVD 和全因死亡率的风险最高，与这两个因素中的任何一个相比都是如此。
