A Community-based Retrospective Cohort Study On The Relationship Between Remnant Cholesterol And Cardiovascular Disease In Beijing

Part ?.Association of remnant cholesterol levels with cardiovascular events incommunity populationObjective:To explore the relationship between remnant cholesterol(RC)level and cardiovascular disease(CVD)events in populations aged 40 years and older and with no previous CVD events in Beijing communities.Methods:This study was designed for a retrospective cohort study.The study population was the community residents in Shijingshan District of Beijing,selected by cluster random sampling in the REACTION cohort study.A total of 9312 community residents aged 40 years or older and with no previous CVD events were included in the study.The subjects were followed up between 2011 years to 2015 years.The demographics,past medical history,living habits,blood glucose,blood lipids etc.data were collected in the baseline survey,and the occurrence of CVD events were ascertained during the following up as the study outcome.Univariate analysis and multivariate analysis(such as Logistic regression and COX regression models)were used to study the association between RC and CVD events,adjusting for the baseline characteristics as the potential confounding factors in the latter analysis.Results:The average follow up time of the participants were 3.2 years.During the follow-up period,321 people(3.45%)had occurred CVD events,and the average RC level of residents with CVD events was higher than those without CVD events(0.58 mmol/L vs.0.54 mmol/L,P=0.002).RC was significantly related to gender,baseline smoking habit,family history of CVD,diabetes,body mass index(BMI),waist circumference(WC),diastolic blood pressure(DBP),2-h postprandial plasma glucose(2h-PG),glycosylated hemoglobin Alc(HbAlc),and Triglyceride(TG).After adjusting for age,sex,Low-density lipoprotein cholesterol(LDL-C),High-density lipoprotein cholesterol(HDL-C)and other traditional CVD risk factors,the risk of CVD events increased by 11%for every 1-SD increase in RC(HR=1.11,95%CI,1.01-1.22,P=0.038).Cardiovascular events increased by 41%in residents with RC levels higher than the 75th percentile,comparing to those with RC levels lower than the 25th percentile(HR=1.41,95%Cl,1.02-2.04,P=0.049).Conclusions:Increased RC levels would increase the risk of CVD among people over 40 years old who have never had CVD events in Beijing community.Part ?.The relationship between RC level and CVD events in differentglycometabolism groups.Objective:To investigate the association between RC level and CVD events in different glucose metabolic states of people over 40 years old in Beijing community.Methods:Study design,subjects,baseline survey,and follow-up were the same as Part I.For the data analysis,firstly according to fasting plasma glucose(FPG)and 2h-PG,the glucose metabolism status was divided into three groups:normal population,impaired glucose tolerance(IGR)and diabetes.The subjects were divided into six groups according to the glucose metabolism status and the 75th percentile of RC.The COX regression model was used to analyze the association between different glucose metabolism status and different RC levels and risk of CVD events.Finally,a subgroup analysis of RC and CVD events was performed in the diabetic population.Results:During the follow-up period,125 people(2.49%)with normal population had CVD events,94 people(4.24%)with IGR had CVD events,and 102 people(4.90%)with diabetes had CVD events.After adjusting for age,sex,LDL-C,HDL-C and other traditional CVD risk factors,the risk of CVD events in diabetic patients was 1.35 times higher than those in normal subjects(HR=1.35,95%CI,1.03-1.77,P?0.033).The risk of CVD events in IGR patients was 1.34 times higher than that in normal subjects(HR=1.34,95%CI,1.03-1.76,P=0.033).People with diabetes and high RC level had higher risk of CVD events than those with normal blood glucose and low RC level(HR=1.80,95%CI,1.09-2.97,P=0.022)and those with normal blood sugar and high RC level(HR=1.53,95%CI,1.03-2.29,P=0.036).In the subgroup analysis in diabetic patients,the risk of CVD events increased by 15%for every 1-SD increase in RC(HR=1.15,95%CI,1.01-1.31,P=0.038),and the risk of CVD events was 1.86 times higher in diabetic patients with HbAlc>6.5%and higher RC level than those with HbAlc<6.5%and lower RC level(HR=1.86,95%Cl,1.01-3.41,P=0.045).Conclusions:Abnormal glucose metabolism and elevated RC levels have a combined effect on the risk of cardiovascular events among people over 40 years old who have never had CVD events in Beijing community.In diabetic patients,elevated RC levels may increase the risk of CVD events.Keywords:Cardiovascular disease;Remnant cholesterol;Cohort studiesPart III.The relationship between RC level and abnormal arterial stiffnessObjective:To explore the relationship between RC level and abnormal arterial stiffness in people over 40 years old in Beijing community.Methods:The study design,selection of subjects,baseline survey and follow-up were the same as in the Part I.This section only includes subjects who meet the brachial-ankle pulse wave velocity(baPWV)<1400cm/s criteria.A total of 1211 community residents are included in this part of the research.In the data analysis,univariate analysis and multivariate logistic regression analysis were used to study the association between RC and arterial stiffness.Results:During follow-up,205(16.93%)patients were found to have abnormal arterial stiffness.The RC level was higher in patients with abnormal arterial stiffness than those with normal arterial stiffness(0.54 mmol/L vs.0.49 mmol/L,P=0.172).Compared with those with normal arterial stiffness,residents with abnormal arterial stiffness were significantly older,and had higher proportion of family history of CVD,higher prevalence of hypertension and diabetes,higher level of BMI,WC,SBP,DBP,FPG,2h-PG,HbA1c and total cholesterol(TC)at baseline,and lower HDL-C levels at baseline.Univariate analysis showed that the risk of abnormal arterial stiffness for people with RC level higher than the 75th percentile was 1.5 time than those RC level lower than that of the 75th percentile(OR=1.50,95%CI,1.05-2.13,P=0.025).After adjusting for age,sex,LDL-C,HDL-C and other traditional CVD risk factors,the risk of abnormal arterial stiffness in the population with RC level above the 75th percentile was 1.19 times that in the population with RC level below the 75th percentile(OR=1.19,95%CI,0.79-1.80,P=0.403).Conclusions:Increased RC level is associated with abnormal arterial stiffness among people over 40 years old in Beijing community,but it is not independent of traditional CVD risk factors.Larger sample size of prospective studies are needed to confirm the results.