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Association between remnant cholesterol and stroke among patients with atrial fibrillation: A population-based cohort

Yemin Li1, Yesheng Ling1, Hongxing Wu1

  • 1Division of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (Y. Li, Ling, H. Wu, J. Luo, S. Li, B. Wu, Xiong, and Huang).

Journal of Clinical Lipidology
|March 19, 2026
PubMed

Insights

Elevated remnant cholesterol (RC) levels, variability, and cumulative exposure increase stroke risk in atrial fibrillation (AF) patients. Lipid-lowering interventions targeting RC are crucial for mitigating stroke risk in this population.

Area of Science:

  • Cardiovascular Medicine
  • Lipid Metabolism
  • Stroke Prevention

Background:

  • Remnant cholesterol (RC) is a known stroke risk factor in the general population.
  • The specific role of RC in stroke risk for patients with atrial fibrillation (AF) is not well-established.

Purpose of the Study:

  • To investigate the association between key remnant cholesterol (RC) metrics and stroke risk in patients with atrial fibrillation (AF).
  • Key RC metrics examined include baseline levels, cumulative measures, average real variability (ARV), and RC/low-density lipoprotein cholesterol (LDL-C) discordance.

Main Methods:

  • Analysis of 2154 AF patients from the Atherosclerosis Risk in Communities database.
  • RC calculated as total cholesterol minus LDL-C and HDL-C.
  • Cox proportional hazards models used to assess associations between 4 RC metrics and stroke risk, with confounder adjustment.

Main Results:

  • Higher baseline RC levels significantly correlated with increased stroke risk (HR=1.41, P=.039).
  • Increased stroke risk observed with higher RC average real variability (ARV) (HR=2.06, P=.041) and cumulative RC levels (HR=1.11, P=.002).
  • Concordant high RC/LDL-C levels were associated with a higher stroke risk (HR=1.93, P=.01).

Conclusions:

  • Elevated baseline RC, variability, and cumulative exposure are independent predictors of stroke risk in AF patients.
  • These findings underscore the importance of targeting RC levels with lipid-lowering therapies to reduce stroke incidence in this high-risk group.
Abstract

Keywords:
ARICAtrial fibrillationRemnant cholesterolStrokeVariability

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