Variations in remnant cholesterol and the risk of cardiovascular disease: a national longitudinal cohort study

Remnant cholesterol (RC) has been recognized as a modifiable risk factor for cardiovascular disease (CVD). However, the association between long-term changes in RC during follow-up and incident CVD remains underexplored, with most research focusing on baseline RC levels. Data for this prospective cohort study were derived from the China Health and Retirement Longitudinal Study (CHARLS). RC levels were calculated using the Friedewald equation. Changes in RC, cumulative RC, and the change in RC (ΔRC) were assessed by comparing RC levels at Waves 1 and 3. Cox proportional hazard models, adjusted for potential confounders, were used to evaluate the impact of baseline and dynamic RC levels on incident CVD risk. Among 3,866 participants (46.23% male, mean age: 57.50 years) followed for 5.0 years, participants with initially high RC who decreased to low levels showed reduced CVD risk (HR 0.71, 95% CI 0.54-0.94). Those with low baseline RC escalating to high levels showed similar risk (HR 0.85, 95% CI 0.68-1.06) compared to consistently high RC levels. Highest tertile cumulative RC significantly increased CVD risk (HR 1.37, 95% CI 1.11-1.69). Among high baseline RC participants, those in the lowest ΔRC tertile had reduced CVD risk (HR 0.68, 95% CI 0.52-0.89). Longitudinal RC increases were associated with higher CVD risks, while RC reductions were associated with decreased risks. RC monitoring and management may contribute to CVD risk assessment and prevention, though further research with direct RC measurement and clinically validated outcomes is needed.