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Remnant cholesterol in patients admitted for acute coronary syndromes
Alberto Cordero1,2,3, Belén Alvarez-Alvarez3,4, David Escribano1,2
1Cardiology Department, Hospital Universitario de San Juan, Carretera Valencia-Alicante sn. San Juan de Alicante, Spain.
Insights
High remnant cholesterol is common in acute coronary syndrome (ACS) patients, linked to body mass index but not immediate death. Elevated levels predict increased long-term mortality and heart failure risk after discharge.
Area of Science:
- Cardiology
- Lipid Metabolism
- Clinical Research
Background:
- Remnant cholesterol is a key lipid marker for coronary heart disease.
- Evidence on remnant cholesterol's role in acute coronary syndrome (ACS) is limited.
Purpose of the Study:
- To investigate the prevalence and prognostic value of remnant cholesterol in ACS patients.
- To determine the association between remnant cholesterol levels and in-hospital and long-term outcomes.
Main Methods:
- A cohort of 7479 ACS patients was analyzed.
- Remnant cholesterol was calculated (Total Cholesterol - LDL - HDL).
- In-hospital and long-term outcomes (mortality, heart failure) were assessed.
Main Results:
- 45.85% of patients had high remnant cholesterol (≥30 mg/dL).
- Levels correlated negatively with age and positively with body mass index.
- No association with in-hospital mortality was found.
- Elevated levels (>60 mg/dL) predicted higher long-term all-cause mortality, cardiovascular mortality, and heart failure re-admission.
Conclusions:
- High remnant cholesterol is prevalent in ACS patients and associated with BMI.
- It does not increase in-hospital mortality risk.
- Remnant cholesterol is a significant predictor of adverse long-term outcomes, including mortality and heart failure.
Background:
Remnant cholesterol has been identified as one of leading lipid values associated with the incidence of coronary heart disease. There is scarce evidence on its distribution and prognostic value in acute coronary syndrome (ACS) patients.
Methods And Results:
We included all consecutive patients admitted for ACS in two different centres. Remnant cholesterol was calculated by the equation: total cholesterol minus LDL cholesterol minus HDL cholesterol, and values ≥30 were considered high. Among the 7479 patients, median remnant cholesterol level was 28 mg/dL (21-39), and 3429 (45.85%) patients had levels ≥30 mg/dL. Age (r: -0.29) and body mass index (r: 0.44) were the variables more strongly correlated. At any given age, patients with overweigh or obesity had higher levels. In-hospital mortality was 3.75% (280 patients). Remnant cholesterol was not associated to higher in-hospital mortality risk (odds ratio: 0.89; P = 0.21). After discharge (median follow-up of 57 months), an independent and linear risk of all-cause mortality and heart failure (HF) associated to cholesterol remnant levels was observed. Remnant cholesterol levels >60 mg/dL were associated to higher risk of mortality [hazard ratio (HR): 1.49 95% CI 1.08-2.06; P = 0.016], cardiovascular mortality (HR: 1.49 95% CI 1.08-2.06; P = 0.016), and HF re-admission (sub-HR: 1.55 95% CI 1.14-2.11; P = 0.005).
Conclusions:
Elevated remnant cholesterol is highly prevalent in patients admitted for ACS and is inversely correlated with age and positively with body mass index. Remnant cholesterol levels were not associated to higher in-hospital mortality risk, but they were associated with higher long-term risk of mortality and HF.
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