Highlights
- •Remnant cholesterol (RC) is a potential contributor to residual cardiovascular risk.
- •Association between calculated RC and myocardial infarction (MI) was investigated.
- •We analyzed 9451 patients with coronary disease undergoing revascularization.
- •RC was a risk factor for MI independent of lipid-lowering drugs, LDL-C or non-HDL-C.
- •When RC and non-HDL-C (or LDL-C) were discordant, RC seemed to better reflect risk.
Background
Despite substantial reduction in low-density lipoprotein cholesterol (LDL-C), patients
develop recurrent cardiovascular events. Remnant cholesterol (RC), the cholesterol
content of triglyceride-rich lipoproteins, is a potential contributor to this residual
risk.
Objectives
To investigate the association between RC and risk for myocardial infarction (MI)
in patients with coronary artery disease, and examine whether the predictive value
of RC is retained beyond non-high-density lipoprotein cholesterol (non-HDL-C).
Methods
Data on 9451 patients undergoing coronary revascularization in a single center. RC
was calculated as total cholesterol minus high-density lipoprotein cholesterol minus
LDL-C (estimated using Martin–Hopkins equation). Cox-regression models were used to
estimate the association between RC and risk for MI. Discordance analyses were performed
to examine the correlation between RC and non-HDL-C (or LDL-C) in relation to MI risk.
Results
Mean age was 65±11 years; 67% presented with acute coronary syndrome. During median
follow-up of 9.6 years, 1690 patients developed MI. After multivariable adjustment
including lipid-lowering therapies and non-HDL-C, RC was associated with higher MI
risk: hazard ratio (95% confidence interval): 1.36 (1.20-1.56) and 1.58 (1.35-1.85)
in those with RC levels ≥75th (32.6 mg/dL) and ≥90th (41.8 mg/dL) percentile, compared
to RC <50th percentile (25.5 mg/dL). When RC and non-HDL-C (or LDL-C) levels were
discordant, the level of RC better reflected the risk for MI.
Conclusions
Elevated RC is a risk factor for MI independent of lipid-lowering therapies and non-HDL-C,
providing further support that RC may serve as a residual cardiovascular risk marker
and potential treatment target in patients with coronary artery disease.
Keywords
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Article info
Publication history
Published online: March 22, 2023
Accepted:
March 15,
2023
Received:
November 7,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Sources of funding: None.
Declaration of Competing Interest: None.
Identification
Copyright
© 2023 National Lipid Association. Published by Elsevier Inc. All rights reserved.
