Zhonghua Yi Xue Za Zhi. 2026 Mar 17;106(10):903-911. doi: 10.3760/cma.j.cn112137-20251226-03425.
ABSTRACT
Objective: To investigate the relationship between long-term cumulative burden of non-high-density lipoprotein cholesterol (Non-HDL-C) and the incidence of cardiovascular disease(CVD). Methods: The study subjects were derived from three prospective sub-cohorts of the China-PAR project. Baseline surveys were carried out in 1998, 2000-2001, and 2007-2008, with follow-up until 2021. A total of 113, 448 participants were included at baseline. Non-HDL-C was calculated as total cholesterol (TC) minus high-density lipoprotein cholesterol (HDL-C). Long-term cumulative exposure to Non-HDL-C was estimated using the time-weighted 10-year cumulative exposure value. According to the cumulative Non-HDL-C exposure levels, participants were categorized into four groups:<34 mmol/L×years, 34~<41 mmol/L×years, 41~<49 mmol/L×years, and≥49 mmol/L×years. Multivariable Cox proportional hazards regression models were used to assess the association between cumulative Non-HDL-C exposure and the risk of incident cardiovascular disease. Restricted cubic spline curves were applied to visualize the exposure-response relationship. Results: A total of 63, 211 participants were finally included, with an average age of (58.2±11.7) years, including 24, 493 men (38.8%). The results of the multivariable Cox proportional hazards regression analysis showed that for each standard deviation increase in Non-HDL-C cumulative exposure level (7.5 mmol/L×year), the risk of CVD, coronary heart disease, and stroke incidence increased by 8% (HR=1.08, 95%CI: 1.05-1.11), 15% (HR=1.15, 95%CI: 1.06-1.22), and 7% (HR=1.07, 95%CI: 1.04-1.11), respectively. Compared with the group with Non-HDL-C cumulative exposure<34 mmol/L×year, the HRs for CVD, coronary heart disease, and stroke incidence in the group with cumulative exposure≥49 mmol/L×year were 1.33 (95%CI: 1.13-1.57), 2.06 (95%CI: 1.53-2.76), and 1.23 (95%CI: 1.01-1.50), respectively. Subgroup analyses showed that the association between cumulative Non-HDL-C levels and the risk of CVD incidence was more pronounced in individuals under 60 years of age (P for interaction<0.05). In participants younger than 60 years of age, each standard deviation increase in Non-HDL-C cumulative exposure (7.5 mmol/L×year) was associated with a 14% increase in the risk of CVD incidence (HR=1.14, 95%CI: 1.08-1.21), higher than the increase of 5% observed in participants aged 60 years or older (HR=1.05, 95%CI: 1.01-1.08). Conclusion: High cumulative Non-HDL-C exposure is associated with an increased risk of CVD incidence.
PMID:41820053 | DOI:10.3760/cma.j.cn112137-20251226-03425