Association of low-grade inflammation and elevated remnant cholesterol with risk of ASCVD and mortality in impaired renal function

BACKGROUND AND AIMS: Low-grade inflammation and elevated remnant cholesterol are associated with increased risk of atherosclerotic cardiovascular disease (ASCVD) and all-cause mortality. We hypothesized that each confers risk of myocardial infarction, ASCVD, and all-cause mortality in individuals with impaired renal function. METHODS: We included 102 906 individuals from the Copenhagen General Population Study, of which 9 935 had impaired renal function with estimated glomerular filtration rate <60 mL/min/1.73 m2. Remnant cholesterol was calculated from a standard lipid profile. ASCVD was myocardial infarction, coronary heart disease death, ischemic stroke, or coronary revascularization. RESULTS: In individuals with impaired renal function, we observed 566 myocardial infarctions, 1 122 ASCVD events, and 3 139 deaths. Compared to individuals with low C-reactive protein and remnant cholesterol, multivariable adjusted hazard ratios for myocardial infarction were 1.12 (95 % confidence intervals: 0.86-1.46) in individuals with low C-reactive protein and high remnant cholesterol, 1.28 (1.00-1.65) in individuals with high C-reactive protein and low remnant cholesterol, and 1.39 (1.10-1.76) in individuals with both high C-reactive protein and remnant cholesterol. Corresponding hazard ratios for ASCVD were 1.07 (0.89-1.28), 1.09 (0.91-1.30), and 1.33 (1.13-1.57); and for all-cause mortality 0.96 (0.85-1.07), 1.18 (1.07-1.30), and 1.20 (1.09-1.33), respectively. CONCLUSIONS: In individuals with impaired renal function, low-grade inflammation and elevated remnant cholesterol jointly conferred the highest risk of myocardial infarction, ASCVD, and all-cause mortality.