Association of Cumulative Exposure to Triglyceride and Remnant Cholesterol With the Risk of Cardiovascular Disease in Hypertensive Patients With Target LDL-C

Abstract

Hypertensive patients are at high risk of cardiovascular disease (CVD) and require intensive lipids management. Triglycerides (TG) and remnant cholesterol (RC) contribute to residual risk beyond low-density lipoprotein cholesterol (LDL-C), and cumulative exposure reflects a more comprehensive assessment. However, their impact on hypertensive patients with target LDL-C levels remains unclear. A total of 9046 hypertensive participants with target LDL-C levels who completed three health examinations (2006‒2010) were enrolled and followed until December 31, 2022. Cumulative burden was calculated as the average level multiplied by the interval between assessments. The primary outcome included a composite of CVD events (myocardial infarction [MI], ischemic stroke [IS], and hemorrhage stroke [HS]). Participants were categorized into four groups according to cumulative triglyceride (cumTG) (≥5.66 vs. <5.66 [median, mmol/L]) and cumulative RC (cumRC) (≥4.20 vs. <4.20 [median, mmol/L]): low cumTG and low cumRC, high cumTG and low cumRC, low cumTG and high cumRC, and high cumTG and high cumRC. Cox models were used to calculate the hazard ratio (HR) and 95% confidence intervals (CI) between the cumulative burden and CVD risk. During a median follow-up of 15.97 years, 1415 participants developed CVD. After multivariable adjustment, compared to the low cumTG/low cumRC group, CVD risk was higher in the high cumTG/high cumRC (HR 1.43, 95% CI 1.24‒1.64) and low cumTG/high cumRC groups (HR 1.24, 95% CI 1.05-1.47), but not in the high cumTG/low cumRC group (HR 1.06, 95% CI 0.89-1.25). In hypertensive patients with target LDL-C levels, high cumRC, rather than cumTG, is associated with an increased risk of CVD. Trial Registration: ChiCTR-TNC-11001489.

Keywords: cumulative exposure; hypertension; remnant cholesterol; triglycerides.