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Published on: February 20, 2017
Remnant Cholesterol in Young Adulthood Is Associated With Left Ventricular Remodeling and Dysfunction in Middle Age:
Xinghao Xu1,2, Zhaoyan Wang3, Rihua Huang1,2
1Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X., R.H., Y.G., Z.X., X.Z., X.L.).
Insights
High remnant cholesterol (RC) in young adulthood is linked to adverse changes in heart structure and function by middle age. Tracking RC levels over time identifies individuals at higher risk for heart remodeling and dysfunction.
Area of Science:
- Cardiology
- Lipid Metabolism
- Cardiovascular Imaging
Background:
- Remnant cholesterol (RC) is increasingly recognized as a risk factor for heart failure.
- The specific impact of RC on left ventricular (LV) structure and function over time remains incompletely understood.
Purpose of the Study:
- To investigate the association between remnant cholesterol levels in young adulthood and subsequent left ventricular structure and function in middle age.
- To examine the long-term trajectories of RC and their relationship with cardiac remodeling.
Main Methods:
- Utilized data from 3321 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study.
- Calculated RC and identified RC trajectories using latent class growth mixture modeling.
- Assessed LV structure and function via echocardiography at study year 25, analyzed with multivariable linear regression.
Main Results:
- Higher baseline RC was significantly associated with increased LV mass index, impaired global longitudinal and circumferential strain, reduced septal and lateral e', and elevated E/e' in middle age.
- Three distinct RC trajectories were identified: low increasing, moderate increasing, and high increasing.
- The high-increasing RC trajectory group exhibited significantly worse LV structure and function compared to the low-increasing group.
Conclusions:
- Elevated remnant cholesterol during young adulthood is associated with detrimental alterations in LV structure and function by midlife.
- Long-term RC trajectories are valuable in identifying individuals susceptible to adverse LV remodeling and dysfunction.
Background:
Recent studies have shown that remnant cholesterol (RC) is associated with incident heart failure; however, its association with left ventricular (LV) structure and function is unclear. We aimed to evaluate the association between RC levels in young adulthood and LV structure and function in middle age.
Methods:
We included 3321 participants from the CARDIA study (Coronary Artery Risk Development in Young Adults) at baseline. RC was calculated as total cholesterol minus high-density lipoprotein cholesterol minus calculated low-density lipoprotein cholesterol, and the RC trajectories that followed a similar pattern of change over time were identified using the latent class growth mixture model. LV structure and function were assessed using echocardiography at CARDIA study year 25. Multivariable linear regression models were performed to assess the associations of both baseline and trajectories of RC levels with LV structure and function.
Results:
Among 3321 participants, the mean age was 24.99±3.62 years: 1450 (43.90%) were male, and 1561 (47.00%) were Black. After multivariate adjustment, higher baseline RC (per SD in log-transformed) was associated with higher LV mass index (β=1.29; P=0.004), worse global longitudinal strain (β=0.19; P<0.001), worse global circumferential strain (β=0.16; P=0.014), lower septal e' (β=-0.26; P<0.001), lower lateral e' (β=-0.18; P=0.003), and higher E/e' (β=0.15; P=0.003). Three RC trajectories were identified during follow-up: low increasing (42.4%), moderate increasing (45.5%), and high increasing (12.1%). Similarly, compared with the low-increasing group, the high-increasing RC trajectory group was related to higher LV mass index, worse global longitudinal strain, lower septal e', lower lateral e', and higher E/e'.
Conclusions:
Elevated RC levels in young adulthood were related to adverse LV structural and functional alterations in midlife. Long-term trajectories of RC levels during young adulthood help identify individuals at a higher risk for adverse LV remodeling and dysfunction.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT00005130.
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