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Original research article
Plasma 7-ketocholesterol levels and the risk of incident cardiovascular events
  1. Min Wang1,
  2. Weiqing Long2,
  3. Di Li3,
  4. Duan Wang4,
  5. Yuan Zhong3,
  6. Di Mu3,
  7. Jiayi Song3,
  8. Min Xia3
  1. 1 Department of Clinical Nutrition, The Affiliated Hospital of Southwest Medical University, Luzhou, China
  2. 2 Department of Clinical Laboratory, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
  3. 3 Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, China
  4. 4 Department of Clinical Nutrition, Guangdong General Hospital, Guangzhou, China
  1. Correspondence to Dr Min Xia, Department of Nutrition, School of Public Health, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou, Guangdong Province 510080, China; xiamin{at}


Objective 7-Ketocholesterol (7-KC), a major oxidation product of cholesterol, is found in human atherosclerotic plaque and more atherogenic than cholesterol in animal models. This study was designed to investigate the association of plasma 7-KC level with the incident cardiovascular disease (CVD) events in general population.

Methods We measured plasma 7-KC concentrations at baseline in 1944 participants free from CVD in a community-based cohort study. The primary endpoint was incident of a major adverse cardiovascular event. A Cox proportional hazards model was used to calculate the HRs with 95% CI.

Results A total of 101 incident CVD events were recorded during the 5.2 year median follow-up. The baseline plasma 7-KC levels were associated with a higher risk of incident CVD events; compared with quartile 1, participants in quartile 4 had an unadjusted HR of 2.38 (2.03–2.85, p<0.001) and an adjusted HR of 1.70 (1.45–1.91, p=0.004) after adjusting for traditional risk factors. Plasma 7-KC levels improved all of the metrics of discrimination and reclassification when added to the intima–media thickness (C-statistic: p=0.002; net reclassification improvement (NRI): p<0.001; integrated discrimination improvement (IDI): p<0.001), family history of myocardial infarction (C-statistic: p=0.011; NRI: p=0.004; IDI: p=0.003) and elevated high-sensitivity C reactive protein (C-statistic: p=0.008; NRI: p=0.015; IDI: p=0.009).

Conclusions Elevated plasma 7-KC levels are associated with the incident CVD events in a population-based cohort. Further studies are needed to confirm this observation.

  • 7-Ketocholesterol
  • Cardiovascular Disease
  • Risk
  • Primary end point

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  • Contributors MW, WQL, DL and DW contributed to data acquisition. MW, WQL, DL, DW, YZ, DM and JYS contributed to data analysis and statistical analyses. MX drafted the manuscript. MW and DL contributed to critical revision of the manuscript.

  • Funding This study was supported by the Funding from the National Natural Science Foundation from Guangdong Province (No. S2012020011104).

  • Competing interests None declared.

  • Ethics approval Institutional Review Board of the Sun Yat-sen University.

  • Provenance and peer review Not commissioned; externally peer reviewed.