An analysis of cohort data from the Multi-Ethnic Study of Atherosclerosis database found that elevated remnant cholesterol is a residual risk factor for aortic valve calcium progression, regardless of the conventional cardiovascular risk factors.
Aortic valve calcium (AVC) is associated with the development of calcific aortic valve disease, which is one of the leading causes of cardiovascular disorders. Remnant cholesterol (RC) plays an important role in atherosclerotic cardiovascular disease and stenosis of the aortic valve. However, there is limited evidence to support the role of RC in AVC progression.
This study analyzed a population-based prospective cohort of Black and White Americans from the Multi-Ethnic Study of Atherosclerosis (MESA) database, whereby the authors evaluated the role of RC on AVC progression in individuals who have optimal low-density lipoprotein cholesterol (LDL-C). The findings are published in the journal Cardiovascular Diabetology.
Baseline Characteristics
The database analysis included a total of 5597 participants, with an average age of 61.8 ± 10.1 years at baseline. Of the total participants, 47.5% were male, 43.4% had hypertension, and 11.7% had diabetes. Clinically detectable AVC at baseline was observed in approximately 12.5% of the study participants. The mean baseline level of RC in the participants was 23.3 ± 8.4 mg/dL.
Remnant Cholesterol and Aortic Valve Calcium Progression
The mean follow-up period of the study was 2.4 ± 0.9 years, during which 10.1% of the participants demonstrated progression of AVC. The percentage of progression significantly increased with increasing RC levels. Following the adjustment of LDL-C and high-density lipoprotein cholesterol (HDL-C), the sensitivity analysis demonstrated a significant relationship between AVC progression and RC levels, which persisted after age, sex, and body mass index stratification.
Aortic Valve Calcium Progression in Lipid-Lowering Treatment
In patients not receiving lipid-lowering agents at baseline, the authors observed a significant relationship between AVC progression risk and RC levels. The authors noted a similar association between the two variables during the follow-up period.
Association of Race With Risk of Aortic Valve Calcium Progression
When participants were stratified by race, the authors noted a stronger and statistically significant positive relationship between the progression of AVC and levels of RC in Hispanic, Chinese, and African American participants compared to Caucasian patients. Moreover, there was a stronger and statistically significant positive relationship between the progression of AVC and levels of RC in participants who had no AVC at baseline.
Aortic Valve Calcium Progression and Lipid Parameters
Compared to the concordant low RC/LDL-C group, the authors noted a significantly increased AVC progression in patients with discordant high RC/low LDL-C, which persisted despite setting the threshold of LDL-C at 100 mg/dL and 130 mg/dL.
Source:
Li, Z., Hao, Q., Zeng, Y., Guo, J., Li, S., Gao, J., & Yang, P. (2024b). Remnant cholesterol and the risk of aortic valve calcium progression: insights from the MESA study. Cardiovascular Diabetology, 23(1). https://doi.org/10.1186/s12933-023-02081-2
