Remnant cholesterol, high-sensitivity C-reactive protein, and risk of incident coronary heart disease among patients with chronic kidney disease based on UK biobank
Minghui Han, Jing Zhou, Zhenzhen Wan, Meng Chen, Mengli Yan, Wei Feng, Ge Wang, Jing Zhang, Lina Zhang, Lei Yan, Fengmin Shao, Yue Gu
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: >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%). CONCLUSIONS: 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.