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Emerging importance of remnant cholesterol compared with low-density lipoprotein cholesterol in cardiovascular risk
Farzam Kamrani1, Mobina Imannezhad1, Ali Rezaee2
1Department of Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran.
Insights
Remnant cholesterol (RC) and LDL-C are key cardiovascular disease (CVD) risk factors. High RC levels significantly increase the risk of CVD and coronary artery disease (CAD), even with low LDL-C.
Area of Science:
- Cardiology
- Lipid Metabolism
- Preventive Medicine
Background:
- Remnant cholesterol (RC) is an emerging risk factor for cardiovascular disease (CVD).
- Its clinical significance is gaining recognition, potentially surpassing traditional lipid markers like LDL-C.
- Understanding the interplay between RC and LDL-C is crucial for accurate CVD risk assessment.
Purpose of the Study:
- To investigate the association between concordant and discordant levels of remnant cholesterol (RC) and low-density lipoprotein cholesterol (LDL-C).
- To examine the incidence of CVD, coronary artery disease (CAD), ischemic stroke, and CVD mortality in relation to RC and LDL-C levels.
- To determine the predictive value of RC and LDL-C, individually and combined, for cardiovascular events.
Main Methods:
- A 10-year prospective cohort study involving 9704 participants in northeastern Iran.
- Baseline measurements of LDL-C and RC were performed.
- Participants were categorized based on RC (<24 mg/dL or ≥24 mg/dL) and LDL-C (<130 mg/dL or ≥130 mg/dL) levels.
- Cox regression analysis was used to assess the risk of CVD, CAD, stroke, and mortality.
Main Results:
- Elevated RC (≥24 mg/dL) was associated with a significantly increased risk of CVD and CAD, irrespective of LDL-C levels.
- Individuals with high RC and low LDL-C had a higher risk of CVD and CAD compared to those with low RC and low LDL-C.
- High LDL-C with low RC also increased CVD and CAD risk, but high RC with low LDL-C provided a more potent risk prediction.
- No significant association was found between RC/LDL-C levels and the incidence of ischemic stroke or CVD mortality.
Conclusions:
- Both elevated remnant cholesterol (RC) and LDL-cholesterol (LDL-C) are significant predictors of cardiovascular disease (CVD) and coronary artery disease (CAD).
- Remnant cholesterol plays a critical role in cardiovascular risk stratification, offering enhanced predictive value over LDL-C alone, particularly when RC is elevated and LDL-C is not.
- Further research is warranted to elucidate the relationship between these lipid parameters and ischemic stroke or CVD mortality.
Abstract:
Remnant cholesterol (RC) has been identified as a risk factor for cardiovascular disease (CVD) for many years. However, its importance was largely overlooked until recently, when it began to receive increased attention, even more so than traditional lipid components. This study examined the relationship between concordant and discordant levels of RC and low-density lipoprotein cholesterol (LDL-C) and incidence of CVD, coronary artery disease (CAD), ischemic stroke, and CVD mortality. This study is part of a 10-year cohort study in northeastern Iran that measured LDL-C and RC at baseline. Outcomes included CVD, CAD, stroke, and mortality. Participants were categorized by RC (< 24 mg/dL or ≥ 24 mg/dL) and LDL levels (< 130 or ≥ 130 mg/dL). A total of 9704 individuals participated in the study. Cox regression analysis revealed that individuals with RC ≥ 24 showed a 1.35- (LDL < 130) and 1.58-fold (LDL ≥ 130) increased risk of CVD (95%Cl: 1.124-1.638 and 1.293-1.95) and a 1.45- (LDL < 130) and 1.63-fold (LDL ≥ 130) increased risk of CAD (95%Cl: 1.186-1.772 and 1.311-2.034), compared to the RC < 24, LDL < 130 group. Additionally, those with RC < 24 and LDL ≥ 130 had a 1.29-fold risk of CVD (95%Cl: 1.020-1.65) and a 1.38-fold risk of CAD (95%Cl: 1.077-1.789). Elevated levels of LDL-C and RC are strong predictors of CVD and CAD. Notably, high RC with low LDL-C offers better risk prediction than high LDL-C with low RC, emphasizing the role of RC in cardiovascular risk assessment. However, no link was found between lipid levels and ischemic stroke or CVD mortality, indicating a need for further research in these areas.
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