ArticleInternational journal of cardiology. Heart & vasculature2026
Remnant cholesterol inflammatory index as a novel predictor of cardiovascular disease: Cross-sectional, longitudinal, and cumulative exposure analyses.
Article in International journal of cardiology. Heart & vasculature, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Traditional cardiovascular risk assessment using individual biomarkers may inadequately capture the complex interactions between atherogenic lipids and systemic inflammation. The remnant cholesterol inflammatory index (RCII) represents a novel composite biomarker integrating these pathways, but comprehensive evaluation of its cardiovascular predictive value remains limited. Methods: We conducted secondary analyses of the China Health and Retirement Longitudinal Study (CHARLS), utilizing three complementary approaches: cross-sectional analysis (n = 10,459), longitudinal cohort analysis (n = 6,028), and cumulative exposure analysis (n = 3,515). RCII was calculated as remnant cholesterol × high-sensitivity C-reactive protein ÷ 10. Primary outcome was cardiovascular disease (CVD), defined as heart disease or stroke. Associations were quantified using logistic and Cox proportional hazards regression models with progressive adjustment strategies. Results: RCII demonstrated consistent associations with CVD across all analytical approaches. In cross-sectional analysis, the highest RCII tertile showed 34% increased odds of prevalent CVD (OR: 1.34, 95% CI: 1.12-1.61). Longitudinal analysis revealed 26% increased hazard for incident CVD (HR: 1.26, 95% CI: 1.07-1.47) over 7-year follow-up. Cumulative exposure analysis demonstrated the strongest association, with 32% increased hazard (HR: 1.32, 95% CI: 1.04-1.67). Dose-response relationships were linear without threshold effects. Associations were particularly pronounced for stroke compared to heart disease. Conclusions: RCII represents a valuable integrated biomarker for cardiovascular risk assessment, with cumulative exposure providing superior predictive performance compared to single-point measurements. These findings support RCII's potential clinical applicability for identifying high-risk individuals requiring intensified prevention strategies targeting both metabolic and inflammatory pathways.
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