Kim Byung Jin, Lee Mi Yeon, Cho Eun Hye, Jang Youngwoo, Kang Jeonggyu
Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (Dr Kim).
Division of Biostatistics, Department of R&D Management, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (Dr Lee).
J Clin Lipidol. 2025 May-Jun;19(3):477-485. doi: 10.1016/j.jacl.2025.02.014. Epub 2025 Feb 21.
Previous studies have investigated the relationship between remnant cholesterol (RC) and mortality outcomes in the general population, but the majority have focused on Western populations.
This study aims to evaluate the association between RC and mortality-related outcomes in a relatively young and middle-aged Korean population.
This cohort study included 268,219 participants (mean age, 38 years; 50.6% men) who were enrolled in the Kangbuk Samsung Health Study between 2003 and 2016. Fasting RC was calculated as total cholesterol minus low-density lipoprotein cholesterol minus high-density lipoprotein cholesterol.
The median RC was 0.47 mmol/L (18 mg/dL) and the prevalence of ≥1 mmol/L RC was 11.4%. During the median follow-up of 6.7 years, compared with the lowest quintile (RC <0.31 mmol/L), the hazard ratios (HRs) and 95% CIs for cardiovascular mortality were 1.95 [0.78, 4.84], 2.47 [1.03, 5.91], 2.39 [1.00, 5.72], and 2.84 [1.19, 6.78] in the second, third, fourth, and highest quintiles, respectively. The HRs for all-cause mortality in the third, fourth, and highest quintiles remained significant but were not significant for the risk of cancer mortality. Subgroup analyses showed that the high RC group with high-sensitivity C-reactive protein (hsCRP) or high lipoprotein(a) levels had more than 2-fold and 3-fold increased risks of cardiovascular mortality than the low RC group with low hsCRP or low lipoprotein(a) levels.
High RC levels were significantly associated with an increased risk of cardiovascular and all-cause mortality, but not with cancer mortality. Specifically, high hsCRP and lipoprotein(a) levels weighted the risk association between high RC and cardiovascular mortality.
以往研究调查了普通人群中残余胆固醇（RC）与死亡结局之间的关系，但大多数研究集中在西方人群。
本研究旨在评估相对年轻和中年的韩国人群中RC与死亡相关结局之间的关联。
这项队列研究纳入了2003年至2016年期间参加江北三星健康研究的268,219名参与者（平均年龄38岁；男性占50.6%）。空腹RC通过总胆固醇减去低密度脂蛋白胆固醇再减去高密度脂蛋白胆固醇来计算。
RC的中位数为0.47 mmol/L（18 mg/dL），RC≥1 mmol/L的患病率为11.4%。在中位随访6.7年期间，与最低五分位数（RC<0.31 mmol/L）相比，第二、第三、第四和最高五分位数中心血管死亡的风险比（HR）及95%置信区间分别为1.95[0.78, 4.84]、2.47[1.03, 5.91]、2.39[1.00, 5.72]和2.84[1.19, 6.78]。第三、第四和最高五分位数中全因死亡的HR仍然显著，但癌症死亡风险不显著。亚组分析显示，与hsCRP或脂蛋白(a)水平低的低RC组相比，hsCRP或脂蛋白(a)水平高的高RC组心血管死亡风险分别增加了2倍多和3倍多。
高RC水平与心血管和全因死亡风险增加显著相关，但与癌症死亡无关。具体而言，高hsCRP和脂蛋白(a)水平加重了高RC与心血管死亡之间的风险关联。
