Investigating the impact of remnant cholesterol on new-onset stroke across diverse inflammation levels: Insights from the China Health and Retirement Longitudinal Study (CHARLS)
Open accessAbstract
BACKGROUND: Prior research underscores the significant impact of remnant cholesterol (RC) on stroke occurrence due to its proatherogenic and proinflammatory traits. This study aims to explore diverse risks of new-onset stroke associated with RC, considering distinct inflammation levels in the middle-aged and senior population in China. METHODS: We analyzed 6509 participants from the China Health and Retirement Longitudinal Study (CHARLS) across four waves (2011-2018). We employed a multivariable Cox proportional hazards regression model, incorporated restricted cubic spline techniques, and conducted sensitivity analyses to evaluate the association among RC, high-sensitivity C-reactive protein (hsCRP), and the risk of new-onset stroke. RESULTS: Over 7 years, 540 new-onset strokes occurred. Individuals in the highest quartile of RC levels exhibited a heightened risk of new-onset stroke, with a multivariable-adjusted hazard ratio (HR) peaking at 1.50 (95% confidence interval 1.12-2.00, P for trend = 0.021), showing a non-linear correlation (P nonlinearity = 0.049). High hsCRP alone had an adjusted HR of 1.10 (95% CI 0.87-1.39), compared to 1.40 (95% CI 1.00-1.96) for high RC alone. Additionally, concurrent high RC and hsCRP showed an adjusted HR of 1.43 (95% CI 1.05-1.96). Consistency persisted across various hsCRP thresholds, after adjusting for additional parameters, or excluding chronic diseases in the primary model, reinforcing result robustness. CONCLUSION: Our findings reveal a substantial and non-linear association between higher baseline RC levels and an elevated risk of new-onset stroke. Moreover, elevated levels of both RC and hsCRP jointly pose the highest risk for new-onset stroke, surpassing the risk associated with each factor individually.
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Systemically, TRLs and their remnants have been linked to markers of low-grade inflammation, including hs-CRP, circulating cytokines such as IL-6 and TNF-α, and immune cell activation.
“Systemically, TRLs and their remnants have been linked to markers of low-grade inflammation, including hs-CRP, circulating cytokines such as IL-6 and TNF-α, and immune cell activation [22–28].”
From Targeting triglycerides for cardiovascular risk reduction (2026) · cites this paper as [24]
The Introduction and Discussion (page numbers unavailable) link remnant cholesterol to low-grade inflammation and report an association with hsCRP. The Discussion mentions proinflammatory cytokines in endothelial cells, but does not link remnants specifically to circulating IL-6 or TNF-α or establish systemic immune-cell activation. (LLM, conf=0.85)
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- Authors
- Xiong, C.-C., Gao, F., Zhang, J.-H., Ruan, Y., Gao, T.-G., Cai, J.-Y., & Liu, S.-F.
- Affiliations
- Xiamen University (CN)
- Fujian Medical University (CN)
- Corresponding author
- Liu, Sui-Feng
- Venue
- International Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2024-06
- Volume
- 405
- Pages
- 131946
- ISSN
- 0167-5273 (ISSN-L)
- OpenAlex
- W4392555157
- Cited by
- 39
- References
- 46
- Citations by year
- 2026: 17 · 2025: 18 · 2024: 4
- FWCI
- 16.47
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- International Journal of Cardiology (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Fujian Provincial Natural Science Foundation (2021J011333)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- remnant cholesterol, new-onset stroke, high-sensitivity C-reactive protein, inflammation, nonlinear relationship, middle-aged and older adults, atherogenic dyslipidemia, stroke risk factors, China Health and Retirement Longitudinal Study
- MeSH terms
- Aged, China, Cholesterol, Female, Follow-Up Studies, Humans, Inflammation, Longitudinal Studies, Male, Middle Aged, Retirement, Risk Factors, Biomarkers, Stroke
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