{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:53:16Z","timestamp":1791175996073,"version":"4.1.0"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite substantial reductions in cardiovascular events with intensive LDL-C lowering, significant residual risk persists. Remnant cholesterol (RC) and C-reactive protein (CRP) reflect lipid dysregulation and inflammation, respectively, and may synergistically promote atherosclerosis. However, large-scale cohort evidence on their combined impact, particularly the quantitative interaction between the two and the modifying role of cholesterol-lowering therapy, remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study included 376,817 participants with a median follow-up of 13.4 years. Cox proportional hazards regression models were used to evaluate the individual and joint associations of RC and CRP with major adverse cardiovascular events (MACE) risk. Stratified analyses by cholesterol-lowering therapy were further conducted to explore its modifying effect on the combined risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Both RC (\u22650.8 mmol\/L) and CRP (\u22652 mg\/L) were independently associated with MACE risk, with adjusted hazard ratios (HR) of 1.074 [95% confidence interval (CI): 1.024\u20131.126] and 1.168 (95% CI: 1.129\u20131.207), respectively. Concurrent elevation of both biomarkers conferred the highest risk (HR = 1.239, 95% CI: 1.167\u20131.316), and a significant positive multiplicative interaction was observed between RC and CRP. Stratified analyses suggested effect modification by cholesterol-lowering medication: the association between isolated RC elevation and MACE was attenuated in medication users, whereas risks remained significant for isolated CRP elevation and combined elevation of both markers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Concurrent elevation of RC and CRP yields the highest MACE risk with a positive additive interaction. Cholesterol-lowering therapy reduces RC-related risk but not inflammation-driven risk in isolated CRP elevation. These findings support combined assessment of both biomarkers for personalized cardiovascular risk stratification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1920077","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:37:12Z","timestamp":1791175032000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Remnant cholesterol, C-reactive protein, cholesterol-lowering medication, and cardiovascular outcome: novel findings from UK Biobank"],"prefix":"10.3389","volume":"13","author":[{"given":"Jing","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Cardiology, The Third Affiliated Hospital of Soochow University","place":["Changzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuan","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, The Third Affiliated Hospital of Soochow University","place":["Changzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian-Jun","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cardiometabolic Center, State Key Laboratory of Cardiovascular Diseases, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li-Chan","family":"Tao","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Third Affiliated Hospital of Soochow University","place":["Changzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1038\/s41586-021-03392-8","article-title":"The changing landscape of 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