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Updated: Jun 9, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Impaired Renal Function With Higher Remnant Cholesterol Related to Risk of Atherosclerotic Cardiovascular Disease: A
Daniel Elías-López1,2,3, Signe Vedel-Krogh1,2,4, Camilla Jannie Kobylecki1,2
1Department of Clinical Biochemistry (D.E.-L., S.V.-K., C.J.K., B.N.W., B.G.N.), Copenhagen University Hospital, Herlev Gentofte, Denmark.
Insights
Higher remnant cholesterol increases atherosclerotic cardiovascular disease (ASCVD) risk in chronic kidney disease patients, even with statin use. Remnant cholesterol, not LDL cholesterol, appears to be a key marker for residual ASCVD risk in impaired renal function.
Area of Science:
- Cardiology
- Nephrology
- Lipid Metabolism
Background:
- Chronic kidney disease (CKD) significantly elevates atherosclerotic cardiovascular disease (ASCVD) risk, partly due to lipid abnormalities.
- Statins are used to mitigate ASCVD risk in CKD patients, but a residual risk remains.
- The role of remnant cholesterol in this residual risk is not fully understood.
Purpose of the Study:
- To investigate the association between higher remnant cholesterol levels and ASCVD risk in individuals with impaired renal function.
- To compare this association in statin users versus nonusers.
Main Methods:
- Utilized data from 107,925 individuals in the Copenhagen General Population Study (2003-2015).
- Included 10,427 individuals with impaired renal function (eGFR < 60 mL/min/1.73 m²).
- Remnant cholesterol was calculated from standard lipid profiles; ASCVD events were tracked through nationwide registries until 2018.
Main Results:
- In individuals with impaired renal function, a 1-mmol/L increase in remnant cholesterol was linked to higher risks of myocardial infarction (HR 1.22), ischemic stroke (HR 1.16), and ASCVD (HR 1.21).
- For ASCVD, hazard ratios were 1.40 in statin users and 1.16 in nonusers with higher remnant cholesterol.
- Elevated remnant cholesterol explained 25% of the excess ASCVD risk in statin users and 8.3% in nonusers with impaired renal function.
Conclusions:
- Higher remnant cholesterol is a significant marker for increased ASCVD risk in individuals with impaired renal function.
- Elevated LDL cholesterol did not show a similar association in this population.
- Patients with CKD and high remnant cholesterol can be identified by elevated non-HDL or apoB levels.
Background:
Chronic kidney disease confers a high risk of atherosclerotic cardiovascular disease (ASCVD), partly due to hyperlipidemia. Although statins reduce the risk of ASCVD in chronic kidney disease, residual risk persists. We investigated whether higher remnant cholesterol is associated with an increased risk of ASCVD in statin users and nonusers with impaired renal function.
Methods:
We included 107 925 individuals from CGPS (Copenhagen General Population Study) initiated in 2003 to 2015, of whom 10 427 had impaired renal function (estimated glomerular filtration rate, <60 mL/min per 1.73 m2). Remnant cholesterol was calculated from a standard lipid profile. ASCVD was myocardial infarction, coronary heart disease death, ischemic stroke, coronary artery bypass graft, or percutaneous coronary intervention extracted from Danish nationwide health registries from baseline through 2018; individuals with events before the start of follow-up were excluded from relevant analysis.
Results:
In individuals with impaired renal function during up to 15 years of follow-up, 597 were diagnosed with myocardial infarction, 618 with ischemic stroke, and 1182 with ASCVD. In these individuals, a 1-mmol/L (39 mg/dL) higher remnant cholesterol level was associated with multivariable-adjusted hazard ratios of 1.22 (95% CI, 1.05-1.42) for myocardial infarction, 1.16 (95% CI, 0.97-1.38) for ischemic stroke, and 1.21 (95% CI, 1.08-1.36) for ASCVD. Corresponding hazard ratios for ASCVD were 1.40 (95% CI, 1.07-1.83) in statin users and 1.16 (95% CI, 1.01-1.34) in nonusers. Of the 1.36-fold excess risk of ASCVD in impaired versus normal renal function, elevated remnant cholesterol and elevated LDL (low-density lipoprotein) cholesterol explained 25% (95% CI, 2.5%-47%) and 0% in statin users and 8.3% (95% CI, 2.4%-14%) and 14% (95% CI, 6.4%-22%) in nonusers, respectively.
Conclusions:
Our results suggest that higher remnant cholesterol is a good marker of increased risk of ASCVD in individuals with impaired renal function, while higher LDL cholesterol may not be. Patients with chronic kidney disease who have high levels of remnant cholesterol are identifiable through higher non-HDL (high-density lipoprotein) cholesterol or apoB levels.
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