Triglyceride-rich lipoproteins cholesterol, 10-years atherosclerotic cardiovascular disease risk, and risk of myocardial infarction and ischemic stroke
Open accessAbstract
Triglyceride-rich lipoproteins cholesterol (TRLs-C) has been associated with atherosclerotic cardiovascular disease (ASCVD), even among individuals with low-density lipoprotein cholesterol in the targeted range. We assessed the associations of TRLs-C with myocardial infarction (MI) and ischemic stroke (IS) and compared the associations with those for other traditional lipids (i.e., triglycerides and non-high-density lipoprotein cholesterol [non-HDL-C]). Included were 327,899 participants from the UK Biobank who were free of MI or IS and did not receive lipid-lowering treatment at baseline. Ten-year risk for ASCVD was estimated by the Pooled Cohort Equations and was grouped as low (<7.5%), intermediate (7.5% to <20%), and high risk (≥20%). Multivariable Cox regression models were used to examine the associations of TRLs-C, triglycerides, and non-HDL-C with risk of MI and IS, overall and by the 10-years risk categories. During a median of 12.3 years of follow-up, 8,358 incident MI and 4,400 incident IS cases were identified. After multivariable adjustment, higher TRLs-C was associated with a higher risk of MI (p-trend <0.0001) but not IS (p-trend = 0.074), with similar associations for triglycerides and non-HDL-C. There were interactions between TRLs-C and 10-years ASCVD risk on risk of MI (p-interaction <0.0001) and IS (p-interaction = 0.0003). Hazard ratios (95% CIs) of MI comparing the highest with the lowest quartiles of TRLs-C were 2.10 (1.23-1.30) in the low-risk group, 1.52 (1.38-1.69) in the intermediate-risk group, and 1.22 (1.03-1.45) in the high-risk group. The corresponding estimates for IS were 1.24 (1.05-1.45), 0.94 (0.83-1.07), and 0.83 (0.67-1.04), respectively. Similar interactions with the 10-years ASCVD risk were observed for triglycerides and non-HDL-C on risk of MI and for triglycerides on risk of IS. Elevated levels of TRLs-C (or triglycerides or non-HDL-C) are associated with a higher risk of developing MI and IS (except non-HDL-C) predominantly among individuals who are typically classified as being low-risk. These findings may have implications for more detailed risk stratification and early intervention.
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Observational cohorts demonstrate that higher TG and remnant cholesterol predict cardiovascular events independently of LDL-C.
“Observational cohorts demonstrate that higher TG and remnant cholesterol predict cardiovascular events independently of LDL-C, while Mendelian randomization analyses confirm a causal relationship between lifelong TRL elevation and ASCVD.”
From Targeting triglycerides for cardiovascular risk reduction (2026) · cites this paper as [42]
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- Authors
- Jia, Y.-P., Wang, J.-M., Lyu, J.-Q., Yang, H.-H., Miao, M.-Y., Wang, X., Wan, Z.-X., Zheng, Y., Qin, L.-Q., Li, F.-R., & Chen, G.-C.
- Affiliations
- Soochow University (CN)
- Peking University (CN)
- Fudan University (CN)
- Corresponding author
- Chen, Guo-Chong
- Venue
- Journal of Lipid Research
- Publisher
- Elsevier BV
- Published
- 2024-11
- Volume
- 65
- Issue
- 11
- Pages
- 100653
- ISSN
- 0022-2275 (ISSN-L)
- PMC
- PMC11536055
- OpenAlex
- W4402676281
- Cited by
- 10
- References
- 46
- Citations by year
- 2026: 5 · 2025: 5
- FWCI
- 4.21
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Lipid Research (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
- Keywords
- atherosclerotic cardiovascular disease risk, myocardial infarction, ischemic stroke, triglycerides, non-HDL cholesterol, lipid-lowering therapy, Pooled Cohort Equations, cardiovascular risk stratification, low LDL cholesterol, dyslipidemia
- MeSH terms
- Ischemic Stroke, Adult, Aged, Cholesterol, Female, Humans, Lipoproteins, Male, Middle Aged, Myocardial Infarction, Risk Factors, Triglycerides, Atherosclerosis
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