| Title: | Residual cardiovascular risk factors and incident myocardial infarction in individuals with low levels of baseline low-density lipoprotein cholesterol: a cohort study |
| Journal: | Nutrition Metabolism and Cardiovascular Diseases |
| Published: | 1 Apr 2026 |
| DOI: | https://doi.org/10.1016/j.numecd.2026.104773 |
Publication 18120
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Abstract
Background and Aim Remnant cholesterol (RC), lipoprotein(a) [Lp(a)], and inflammation are considered key residual cardiovascular risk (RCVR) factors. This study aimed to prospectively evaluate the independent and combined associations of RC, Lp(a), and C-reactive protein (CRP) with myocardial infarction (MI) risk in a general population with baseline low-density lipoprotein cholesterol (LDL-C) <2.6 mmol/L. Methods and Results Baseline RC, Lp(a), and CRP levels were categorized as high or low according to reference thresholds derived from a restricted cubic spline model. Participants were further classified by the number of elevated RCVR factors (0-3). Independent and combined associations of these biomarkers with MI risk were assessed, and their predictive performance was compared. Over a median follow-up of 13.6 years, 1,665 MI events were documented. Multivariate-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were 1.042 (0.924-1.175) for elevated RC, 1.255 (1.137-1.385) for high Lp(a), and 1.246 (1.123-1.384) for high CRP. Compared with participants with no elevated RCVR factors, adjusted HRs (95% CIs) for those with 1, 2, and 3 elevated factors were 1.413 (1.147-1.740), 1.566 (1.271-1.931), and 1.870 (1.493-2.343), respectively. The combined model including all three biomarkers demonstrated superior predictive performance compared with individual markers (DeLong test p < 0.01). Conclusions Elevated Lp(a) and CRP were independently associated with increased MI risk, whereas RC was not. A combined assessment of RCVR factors provided greater predictive value than any single biomarker.</p>
6 Authors
- Chi Chen
- Fuli Chen
- Yang Tian
- Wenjuan Chen
- Gang Li
- Long Zhou
1 Application
| Application ID | Title |
|---|---|
| 129048 | Effects of environmental and nutritional exposures on the risk of cardiovascular and cerebrovascular diseases and its potential mechanisms |
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