Remnant Cholesterol, Not LDL Cholesterol, Is Associated With Incident Cardiovascular Disease

Area of Science:

• Cardiovascular Medicine
• Lipid Metabolism
• Preventive Cardiology

Background:

• Circulating triglycerides and remnant cholesterol are known predictors of cardiovascular events.
• Triglyceride-rich lipoproteins carry cholesterol and are implicated in cardiovascular risk.
• Understanding these lipid fractions is crucial for cardiovascular event prediction.

Purpose of the Study:

• To evaluate the association between triglycerides, remnant cholesterol (remnant-C), and major adverse cardiovascular events (MACEs).
• To assess these associations in a cohort of older individuals at high cardiovascular risk.
• To determine if remnant-C predicts MACEs independently of LDL-C levels.

Main Methods:

• Analysis of the PREDIMED trial population (N=6,901) with a median follow-up of 4.8 years.
• Baseline lipid profiles and incident MACEs were determined.
• Cox proportional hazard models were used to assess associations between lipid concentrations and MACEs.

Main Results:

• Triglycerides (HR: 1.04), non-HDL-C (HR: 1.05), and remnant-C (HR: 1.21) were associated with MACEs.
• Remnant-C levels ≥30 mg/dl identified subjects at higher risk, irrespective of LDL-C control.
• Atherogenic dyslipidemia was also associated with increased MACEs (HR: 1.44).

Conclusions:

• In overweight/obese, high-risk individuals, triglycerides and remnant-C are associated with cardiovascular outcomes.
• These associations are independent of other cardiovascular risk factors.
• LDL-C levels were not independently associated with MACEs in this cohort.