Han Minghui, Zhou Jing, Wan Zhenzhen, Chen Meng, Yan Mengli, Feng Wei, Wang Ge, Zhang Jing, Zhang Lina, Yan Lei, Shao Fengmin, Gu Yue
Department of Nephrology, Henan Provincial Key Laboratory of Kidney Disease and Immunology, Henan Provincial People's Hospital, Henan Provincial Clinical Research Center for Kidney Disease, Zhengzhou University People's Hospital, Zhengzhou, 450003, Henan, China.
Department of Nephrology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, 450003, Henan, China.
Nutr Metab (Lond). 2025 Jul 25;22(1):83. doi: 10.1186/s12986-025-00982-5.
Patients with chronic kidney disease (CKD) exhibit elevated remnant cholesterol (RC) and high-sensitivity C-reactive protein (hs-CRP), and both of them contribute to the residual cardiovascular risk. However, the independent effects of RC and its joint effects with hs-CRP remain unknown. This study aimed to explore the associations of RC and its joint categories with hs-CRP with coronary heart disease (CHD), myocardial infarction (MI), and angina among patients with CKD.
This prospective study included 21,914 participants with CKD free of CHD from UK Biobank. RC was calculated as non-high-density lipoprotein cholesterol minus measured low-density lipoprotein cholesterol. Cox models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for CHD. Fine and Gray's model with age as the underlying timescale was used to evaluate the lifetime risks.
Over a median follow-up of 11.99 years, 3403 CHD cases were documented. RC was positively associated with CHD, MI, and angina in a linear manner (P >0.05), with HRs (95% CIs) of 1.09 (1.06-1.13), 1.10 (1.05-1.17), and 1.13 (1.07-1.19) for per standard deviation increase. Compared with low RC/low hs-CRP, low RC/high hs-CRP and high RC/low hs-CRP had 29% (HR 1.29, 95% CI 1.19-1.39) and 44% (1.44, 1.25-1.67) increased risk of CHD, and high RC/high hs-CRP had the highest risk (1.56, 1.38-1.75). Consistent associations were also observed for MI and angina. Moreover, the cumulative CHD risk by age of 80 among high RC/high hs-CRP was much higher than that among low RC/low hs-CRP (35.17% vs. 25.27%).
Elevated RC was linearly and positively associated with increased risk of incident CHD. Combined high RC and hs-CRP conferred the highest relative and absolute risks. Our findings highlighted the importance of targeting RC and hs-CRP combined to reduce the cardiovascular risk among patients with CKD.
慢性肾脏病（CKD）患者的残余胆固醇（RC）和高敏C反应蛋白（hs-CRP）水平升高，二者均会导致残余心血管风险。然而，RC的独立作用及其与hs-CRP的联合作用仍不清楚。本研究旨在探讨CKD患者中RC及其联合类别与hs-CRP和冠心病（CHD）、心肌梗死（MI）及心绞痛之间的关联。
这项前瞻性研究纳入了英国生物银行的21914例无CHD的CKD患者。RC的计算方法为非高密度脂蛋白胆固醇减去实测低密度脂蛋白胆固醇。应用Cox模型估计CHD的风险比（HR）和95%置信区间（CI）。采用以年龄为潜在时间尺度的Fine和Gray模型评估终生风险。
在中位随访11.99年期间，记录了3403例CHD病例。RC与CHD、MI和心绞痛呈线性正相关（P<0.05），每增加一个标准差，HR（95%CI）分别为1.09（1.06 - 1.13）、1.10（1.05 - 1.17）和1.13（1.07 - 1.19）。与低RC/低hs-CRP相比，低RC/高hs-CRP和高RC/低hs-CRP患CHD的风险分别增加29%（HR 1.29，95%CI 1.19 - 1.39）和44%（1.44，1.25 - 1.67），而高RC/高hs-CRP的风险最高（1.56，1.38 - 1.75）。在MI和心绞痛方面也观察到了一致的关联。此外，高RC/高hs-CRP组80岁时的累积CHD风险远高于低RC/低hs-CRP组（35.17%对25.27%）。
RC升高与CHD发病风险增加呈线性正相关。RC和hs-CRP均升高会带来最高的相对和绝对风险。我们的研究结果强调了联合针对RC和hs-CRP以降低CKD患者心血管风险的重要性。
