Huang Qiujin, Qiu Weida, Chen Chaolei, Wang Jiabin, Ou Yanqiu, Feng Yingqing
Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences Southern Medical University Guangzhou 510080 China.
J Am Heart Assoc. 2025 Jun 3;14(11):e040039. doi: 10.1161/JAHA.124.040039. Epub 2025 May 26.
The association between heart failure (HF) and remnant cholesterol (RC) has not been comprehensively elucidated.
This study assessed data from 90 280 individuals (mean age, 54 years; 61.2% women) in the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project, all free of cardiovascular disease at baseline. RC was calculated by the equation: total cholesterol minus high-density lipoprotein cholesterol minus low-density lipoprotein cholesterol (LDL-C), with low-density lipoprotein cholesterol derived using the Friedewald equation. Cox proportional hazards model was used to examine the relationship of RC to HF risk. We also assessed the correlation between left ventricular structure and function and RC levels using multivariable linear regression models in 15 004 participants with echocardiographic data.
The study had a median follow-up period of 3.52 years and recorded 1105 new-onset HF events. In multivariable models, every SD increment in RC was associated with a 7% increased risk of HF (hazard ratio [HR], 1.07 [95% CI, 1.01-1.13]), with a noted gradient of association. Even after accounting for interim myocardial infarction/coronary heart disease, individuals with high baseline RC (≥1.1 mmol/L) remained at a 24% greater HF risk (HR, 1.24 [95% CI, 1.05-1.46]) than the low group (<0.63 mmol/L). Each SD in the log-transformed baseline RC increase was significantly correlated with increases in relative wall thickness (β=0.0014; =0.01) and left ventricular mass index (β=0.45; =0.01).
Elevated RC is linked to unfavorable left ventricular structure and function alterations, increasing the risk of subsequent HF. This association with HF appears to be independent of interim myocardial infarction/coronary heart disease.
心力衰竭（HF）与残余胆固醇（RC）之间的关联尚未得到全面阐明。
本研究评估了中国心脏事件万人项目中90280名个体（平均年龄54岁；61.2%为女性）的数据，所有个体在基线时均无心血管疾病。RC通过以下公式计算：总胆固醇减去高密度脂蛋白胆固醇减去低密度脂蛋白胆固醇（LDL-C），其中低密度脂蛋白胆固醇使用Friedewald公式得出。采用Cox比例风险模型来检验RC与HF风险之间的关系。我们还在15004名有超声心动图数据的参与者中，使用多变量线性回归模型评估左心室结构和功能与RC水平之间的相关性。
该研究的中位随访期为3.52年，记录了1105例新发HF事件。在多变量模型中，RC每增加1个标准差与HF风险增加7%相关（风险比[HR]，1.07[95%置信区间，1.01 - 1.13]），且存在显著的关联梯度。即使在考虑了中期心肌梗死/冠心病之后，基线RC高（≥1.1 mmol/L）的个体发生HF的风险仍比低组（<0.63 mmol/L）高24%（HR，1.24[95%置信区间，1.05 - 1.46]）。对数转换后的基线RC每增加1个标准差与相对室壁厚度增加（β = 0.0014；P = 0.01）和左心室质量指数增加（β = 0.45；P = 0.01）显著相关。
RC升高与不良的左心室结构和功能改变有关，增加了随后发生HF的风险。这种与HF的关联似乎独立于中期心肌梗死/冠心病。
