Effect of dual residual risk of cholesterol and inflammation on all-cause mortality in patients with cardiovascular disease
Abstract Background Randomized controlled trials confirm that risks of residual cholesterol and residual inflammation remains in patients with cardiovascular disease (CVD) even after lipid-lowering therapy. This study aims to investigate the association between dual residual risk of cholesterol and...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-04-01
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| Series: | Cardiovascular Diabetology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12933-023-01826-3 |
| _version_ | 1797836641136541696 |
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| author | Ling Yang Qing Yue Fang Fang Yinggen Zhang Peipei Liu Zihao Zhang Guodong Wang Shuohua Chen Shouling Wu Xiuhong Yang |
| author_facet | Ling Yang Qing Yue Fang Fang Yinggen Zhang Peipei Liu Zihao Zhang Guodong Wang Shuohua Chen Shouling Wu Xiuhong Yang |
| author_sort | Ling Yang |
| collection | DOAJ |
| description | Abstract Background Randomized controlled trials confirm that risks of residual cholesterol and residual inflammation remains in patients with cardiovascular disease (CVD) even after lipid-lowering therapy. This study aims to investigate the association between dual residual risk of cholesterol and inflammation and all-cause mortality in a real-world population with CVD. Methods Patients with a CVD history who first took statins between 1 January 2010 and 31 December 2017 in the Kailuan Study were selected as study participants. According to low-density lipoprotein cholesterol (LDL-C) and hypersensitive C-reactive protein levels, patients were divided into those with no residual risk, residual inflammatory risk (RIR), residual cholesterol risk (RCR), and residual cholesterol and inflammatory risk (RCIR). Cox proportional hazard model was conducted to determine hazard ratio (HR) of all-cause mortality for RIR, RCR, and RCIR. Stratified analysis was conducted according to good medication adherence and 75% of the percentage LDL-C decline, high SMART 2 risk score, and blood pressure and blood glucose at standard levels. Results After 6.10 years of follow-up, 377 all-cause deaths occurred in 3509 participants (mean age 63.69 ± 8.41 years, 86.78% men). After adjusting for related risk factors, the HR and (95% confidence interval [CI]) of all-cause mortality in the RIR, RCR, and RCIR was 1.63 (1.05, 2.52), 1.37 (0.98, 1.90), and 1.75 (1.25, 2.46), compared with no residual risk. Similar associations were observed in participants with moderate or low statin compliance, a lower percentage of LDL-C decline, high SMART 2 risk score, uncontrolled blood pressure, and uncontrolled blood glucose, in the RCIR had a 1.66-fold, 2.08-fold, 1.69-fold, 2.04-fold, and 2.05-fold higher risk of all-cause mortality, respectively, than the reference. Conclusion Risks of residual cholesterol and residual inflammation remain in patients with CVD after receiving statins, and their combined effect significantly increases the risk of all-cause mortality. Here, this increased risk was dependent on statin compliance, LDL-C reduction, SMART 2 risk score, and blood pressure and blood glucose control. |
| first_indexed | 2024-04-09T15:13:17Z |
| format | Article |
| id | doaj.art-c7a763926445480d8ff45c15ec3e122b |
| institution | Directory Open Access Journal |
| issn | 1475-2840 |
| language | English |
| last_indexed | 2024-04-09T15:13:17Z |
| publishDate | 2023-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Diabetology |
| spelling | doaj.art-c7a763926445480d8ff45c15ec3e122b2023-04-30T11:06:34ZengBMCCardiovascular Diabetology1475-28402023-04-0122111010.1186/s12933-023-01826-3Effect of dual residual risk of cholesterol and inflammation on all-cause mortality in patients with cardiovascular diseaseLing Yang0Qing Yue1Fang Fang2Yinggen Zhang3Peipei Liu4Zihao Zhang5Guodong Wang6Shuohua Chen7Shouling Wu8Xiuhong Yang9School of Public Health, North China University of Science and TechnologySchool of Public Health, North China University of Science and TechnologyHebei Key Laboratory for Chronic Diseases, Tangshan Key Laboratory for Preclinical and Basic Research On Chronic Diseases, School of Basic Medical Sciences, North China University of Science and TechnologyDepartment of Nuclear Medicine, Kailuan General HospitalSchool of Public Health, North China University of Science and TechnologySchool of Public Health, North China University of Science and TechnologyDepartment of Cardiology, Kailuan General HospitalDepartment of Cardiology, Kailuan General HospitalDepartment of Cardiology, Kailuan General HospitalSchool of Public Health, North China University of Science and TechnologyAbstract Background Randomized controlled trials confirm that risks of residual cholesterol and residual inflammation remains in patients with cardiovascular disease (CVD) even after lipid-lowering therapy. This study aims to investigate the association between dual residual risk of cholesterol and inflammation and all-cause mortality in a real-world population with CVD. Methods Patients with a CVD history who first took statins between 1 January 2010 and 31 December 2017 in the Kailuan Study were selected as study participants. According to low-density lipoprotein cholesterol (LDL-C) and hypersensitive C-reactive protein levels, patients were divided into those with no residual risk, residual inflammatory risk (RIR), residual cholesterol risk (RCR), and residual cholesterol and inflammatory risk (RCIR). Cox proportional hazard model was conducted to determine hazard ratio (HR) of all-cause mortality for RIR, RCR, and RCIR. Stratified analysis was conducted according to good medication adherence and 75% of the percentage LDL-C decline, high SMART 2 risk score, and blood pressure and blood glucose at standard levels. Results After 6.10 years of follow-up, 377 all-cause deaths occurred in 3509 participants (mean age 63.69 ± 8.41 years, 86.78% men). After adjusting for related risk factors, the HR and (95% confidence interval [CI]) of all-cause mortality in the RIR, RCR, and RCIR was 1.63 (1.05, 2.52), 1.37 (0.98, 1.90), and 1.75 (1.25, 2.46), compared with no residual risk. Similar associations were observed in participants with moderate or low statin compliance, a lower percentage of LDL-C decline, high SMART 2 risk score, uncontrolled blood pressure, and uncontrolled blood glucose, in the RCIR had a 1.66-fold, 2.08-fold, 1.69-fold, 2.04-fold, and 2.05-fold higher risk of all-cause mortality, respectively, than the reference. Conclusion Risks of residual cholesterol and residual inflammation remain in patients with CVD after receiving statins, and their combined effect significantly increases the risk of all-cause mortality. Here, this increased risk was dependent on statin compliance, LDL-C reduction, SMART 2 risk score, and blood pressure and blood glucose control.https://doi.org/10.1186/s12933-023-01826-3Low-density lipoprotein cholesterolHypersensitive C-reactive proteinResidual riskAll-cause mortality |
| spellingShingle | Ling Yang Qing Yue Fang Fang Yinggen Zhang Peipei Liu Zihao Zhang Guodong Wang Shuohua Chen Shouling Wu Xiuhong Yang Effect of dual residual risk of cholesterol and inflammation on all-cause mortality in patients with cardiovascular disease Cardiovascular Diabetology Low-density lipoprotein cholesterol Hypersensitive C-reactive protein Residual risk All-cause mortality |
| title | Effect of dual residual risk of cholesterol and inflammation on all-cause mortality in patients with cardiovascular disease |
| title_full | Effect of dual residual risk of cholesterol and inflammation on all-cause mortality in patients with cardiovascular disease |
| title_fullStr | Effect of dual residual risk of cholesterol and inflammation on all-cause mortality in patients with cardiovascular disease |
| title_full_unstemmed | Effect of dual residual risk of cholesterol and inflammation on all-cause mortality in patients with cardiovascular disease |
| title_short | Effect of dual residual risk of cholesterol and inflammation on all-cause mortality in patients with cardiovascular disease |
| title_sort | effect of dual residual risk of cholesterol and inflammation on all cause mortality in patients with cardiovascular disease |
| topic | Low-density lipoprotein cholesterol Hypersensitive C-reactive protein Residual risk All-cause mortality |
| url | https://doi.org/10.1186/s12933-023-01826-3 |
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