Research Paper Volume 12, Issue 12 pp 11990—12001

The impact of the cumulative burden of LDL-c and hs-CRP on cardiovascular risk: a prospective, population-based study

Jinglin Mo1,2, *, , Zimo Chen1,2, *, , Jie Xu1,2, , Anxin Wang1,2, , Xia Meng1,2, , Xingquan Zhao1,2, , Hao Li1,2, , Shouling Wu3, , Yongjun Wang1,2, ,

  • 1 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  • 2 China National Clinical Research Center for Neurological Diseases, Beijing, China
  • 3 Department of Cardiology, Kailuan General Hospital, Tangshan, China
* Equal contribution

Received: January 5, 2020       Accepted: May 20, 2020       Published: June 16, 2020
How to Cite

Copyright © 2020 Mo et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Background: This study aims to demonstrate the impact of the cumulative burden of low density lipoprotein-cholesterol (cumLDL-c) and high sensitivity C-reactive protein (cumhs-CRP) on cardiovascular risk.

Results: During the 4.62 (±0.70) years of follow-up, 2,148 (5.92%) participants had MACE. Both of cumLDL-c and cumhs-CRP were independent risk factors for MACE. In participants without cumLDL-c during 2006-2013, the participants with cumhs-CRP had higher MACE risk during the subsequent 5 years, than those without cumhs-CRP (hazard ratio [HR]: 1.24, 95% confidence interval [CI]:1.04-1.47). In addition, cumhs-CRP correlated with MACE in a cumhs-CRP level-dependent pattern.

Conclusion: This study validated the effects of residual inflammation risk in patients with low LDL-c Level in a general population, using long-term burdens of hs-CRP or LDL-c other than a single time-point level.

Method: The Kailuan study is a prospective, population-based study began in 2006. These total 36,421 participants completed 4 measurements of hs-CRP and LDL-c biennially from 2006-2013. Cumhs-CRP or cumLDL-c levels were calculated as the number of interval years multiplied by the Δhs-CRP (more than 2.0 mg/L) or ΔLDL-c (more than 2.6 mmol/L). Outcomes measured during follow-up (2012-2017) were defined as major adverse cardiac events (MACE), including ischemic stroke, myocardial infarction, and all-cause mortality.


cumLDL-c: cumulative burden of low density lipoprotein-cholesterol; cumhs-CRP: cumulative burden of high sensitivity C-reactive protein; LDL-c: low density lipoprotein-cholesterol; hs-CRP: high sensitivity C-reactive protein; MACE: major adverse cardiac events; CVD: cardiovascular disease; CANTOS: Canakinumab anti-inflammatory Thrombosis Outcome Study; MI: myocardial infarctions; IS: ischemic strokes; FBG: fast blood glucose; SBP: systolic blood pressure; DBP: diastolic blood pressure; TG: triglyceride; TCHO: total cholesterol; HDL-c: high density lipoprotein cholesterol; HR: hazard ratio; CI: confidence interval; IQR: interquartile ranges; SD: standard deviation.