Age dependent association between remnant cholesterol and cardiovascular disease

High remnant cholesterol is associated with cardiovascular disease (CVD), but whether CVD risk attributable to remnant cholesterol vary between young and later adults remains unknown. The study aimed to assess age differences in the association between remnant cholesterol and CVD.

This prospective study included 95 663 participants without CVD and lipid-lowering treatment at baseline, including 16 254 young adults (age 18-39 years) and 79 409 later adults (age ≥40 years). Individuals were grouped by clinically meaningful remnant cholesterol concentrations of <0.50, 0.50-0.99, 1.00-1.49, and ≥1.50 mmol/L. Multivariable Cox regressions were performed to calculate hazard ratio (HR).

During a median follow-up of 11.01 years, 164 incident CVD were identified in young adults, and 6081 cases in later adults. After multivariate adjustment, the association between remnant cholesterol and CVD was more pronounced in young adults than later adults (P for interaction=0.0019), the HR was 2.24 (95% confidence interval [CI], 1.45-3.47) for young individuals with remnant cholesterol ≥1.50 mmol/L, compared to individuals with remnant cholesterol <0.50 mmol/L, while the corresponding HR was 1.21 (95% CI, 1.13-1.29) for later adults. Furthermore, the population attributable risk percentage for remnant cholesterol < 1.50 vs ≥ 1.50 mmol/L was also higher in young (14.8%) than later adults (4.2%).

Despite a lower incidence risk of CVD among young adults compared later adults, the stronger association and greater attributable risk of remnant cholesterol among young adults highlight the importance of preventive efforts across the adult life course.