Remnant cholesterol as a risk factor for cardiovascular, cancer or other causes mortality: A competing risks analysis

• Published in: Nutrition, metabolism, and cardiovascular diseases metabolism, and cardiovascular diseases, 2020-10, Vol.30 (11), p.2093-2102
• Main Authors: Bonfiglio, Caterina, Leone, Carla M., Silveira, Liciana V.A., Guerra, Rocco, Misciagna, Giovanni, Caruso, Maria G., Bruno, Irene, Buongiorno, Claudia, Campanella, Angelo, Guerra, Vito M.B., Notarnicola, Maria, Deflorio, Valentina, Franco, Isabella, Bianco, Antonella, Mirizzi, Antonella, Aballay, Laura R., Cisternino, Anna M., Sorino, Paolo, Pesole, Pasqua L., Osella, Alberto R.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biomarkers - blood; Cardiovascular Diseases - blood; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - mortality; Cause of Death; Cause-specific mortality; Cholesterol - blood; Competing-risks; Female; Heart Disease Risk Factors; Humans; Italy - epidemiology; Lipoproteins - blood; Male; Middle Aged; Neoplasms - blood; Neoplasms - diagnosis; Neoplasms - mortality; Prognosis; Remnant cholesterol; Risk Assessment; Survival analysis; Triglycerides - blood
• ISSN: 0939-4753; 1590-3729
• DOI: 10.1016/j.numecd.2020.07.002

Cardiovascular diseases (CVDis) are leading causes of morbidity and mortality. Even after the introduction of pharmacological therapy to lower Cholesterol, there is still a residual risk that may be ascribed to remnant cholesterol (RC). We aimed, by analyzing two prospective cohort studies, to estimate the effect of RC on risk and hazard of cardiovascular deaths (CVDs), while accounting for competing risks such as cancer (CDs) and other-causes deaths (OCDs). Cohorts were enrolled in 1992 and 2005. Personal data history was recorded. A fasting venous blood sample was obtained, and RC was calculated at baseline. Cause of Death was coded by using ICD-10th version. Follow-up ended on December 31, 2017. Flexible parametric competing-risks models were applied, with age at death as time-axis. In total, 5729 subjects were enrolled. There were 861 (15.1%) deaths: 234 CVDs (27.2%), 245 CDs (28.5%), 271 OCDs (31.5%) and 111 unknown causes of death (12.8%). RC exposure was a strong risk factor only for CVDs (Risk 2.54, 95% Confidence Interval 1.21; 5.34; Trend 1.26 (1.00; 1.58) for ≥1.29 mmol/L). RC is a strong independent risk factor for cardiovascular mortality. Competing risk analysis is demonstrably a useful tool to disentangle associations among different competing events with a common risk factor. [Display omitted] •Remnant cholesterol is nowadays of great scientific interest.•Remnant cholesterol is associated with cardiovascular events and all-cause mortality.•Competitive risks analysis allows probing the complex relationship between causes of death.•Remnant cholesterol is a strong risk factor for cause-specific cardiovascular deaths.