Why the study?
Remnant cholesterol is associated with incident heart failure, but its association with left ventricular structure and function is unclear.
Are elevated remnant cholesterol levels in young adulthood associated with adverse left ventricular remodeling and dysfunction in middle age?
Are elevated remnant cholesterol levels in young adulthood associated with adverse left ventricular remodeling and dysfunction in middle age?
Elevated remnant cholesterol levels in young adulthood are significantly associated with adverse left ventricular structural and functional alterations 25 years later in midlife.
Hypothesis-generating for remnant cholesterol as early LV risk marker; prospective trials needed before clinical consideration.
BACKGROUND: Recent studies have shown that remnant cholesterol (RC) is associated with incident heart failure; however, its association with left ventricular (LV) structure and function is unclear. We aimed to evaluate the association between RC levels in young adulthood and LV structure and function in middle age. METHODS: We included 3321 participants from the CARDIA study (Coronary Artery Risk Development in Young Adults) at baseline. RC was calculated as total cholesterol minus high-density lipoprotein cholesterol minus calculated low-density lipoprotein cholesterol, and the RC trajectories that followed a similar pattern of change over time were identified using the latent class growth mixture model. LV structure and function were assessed using echocardiography at CARDIA study year 25. Multivariable linear regression models were performed to assess the associations of both baseline and trajectories of RC levels with LV structure and function. RESULTS: Among 3321 participants, the mean age was 24.99±3.62 years: 1450 (43.90%) were male, and 1561 (47.00%) were Black. After multivariate adjustment, higher baseline RC (per SD in log-transformed) was associated with higher LV mass index (β=1.29; P =0.004), worse global longitudinal strain (β=0.19; P <0.001), worse global circumferential strain (β=0.16; P =0.014), lower septal e′ (β=−0.26; P <0.001), lower lateral e′ (β=−0.18; P =0.003), and higher E/e′ (β=0.15; P =0.003). Three RC trajectories were identified during follow-up: low increasing (42.4%), moderate increasing (45.5%), and high increasing (12.1%). Similarly, compared with the low-increasing group, the high-increasing RC trajectory group was related to higher LV mass index, worse global longitudinal strain, lower septal e′, lower lateral e′, and higher E/e′. CONCLUSIONS: Elevated RC levels in young adulthood were related to adverse LV structural and functional alterations in midlife. Long-term trajectories of RC levels during young adulthood help identify individuals at a higher risk for adverse LV remodeling and dysfunction. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00005130.
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Xu et al. (2023) studied this question.
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