Remnant cholesterol, C-reactive protein, and risks of lung cancer morbidity and mortality among women: a prospective cohort study.

Abstract

Introduction: Previous studies have highlighted the importance of blood lipid levels in lung cancer. However, evidence of the association between remnant cholesterol (RC) and lung cancer remains scarce. This study aimed to investigate the association of RC with lung cancer morbidity and mortality and to evaluate their joint effects with C-reactive protein (CRP) in women.

Methods: This prospective cohort study included 198,154 women initially without cancer from the UK Biobank. RC was calculated as non-high-density lipoprotein cholesterol minus the measured low-density lipoprotein cholesterol. Cox models were adopted to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the incidence of lung cancer. Data was collected between 2006 and 2022 and analyzed in 2025.

Results: During a median follow-up of 11.80-13.90 years, 1552 lung cancer cases and 1074 related deaths were identified. RC was positively associated with lung cancer morbidity and mortality in a linear manner, with respective HRs (95% CIs) of 1.50 (1.23-1.82) and 1.40 (1.11-1.77) in quartile 4. Compared with the low RC/low CRP group, the risk of incident lung cancer and lung cancer mortality increased by 115% and 102%, respectively, in the high RC/high CRP group. The cumulative risks of lung cancer by age 80 years were higher in the high RC/high CRP group than in the low RC/low CRP group (morbidity: 3.64% vs. 1.56%; mortality: 1.97% vs. 0.82%).

Conclusions: This study found linear and positive associations of RC with lung cancer morbidity and mortality among women. The combination of high RC and CRP conferred the highest relative and absolute risks. These findings highlighted the importance of considering the combination of RC and CRP levels for the primary prevention of lung cancer and selection of high-risk populations for lung cancer screening among women.