Title
Remnant cholesterol predicts cardiovascular disease beyond LDL and ApoB: A primary prevention study
Date Issued
07 November 2021
Access level
open access
Resource Type
journal article
Author(s)
Martin S.S.
Michos E.D.
Lamba I.
Blumenthal R.S.
Saeed A.
Lima J.
Puri R.
Nomura S.
Tsai M.
Wilkins J.
Ballantyne C.M.
Nicholls S.
Jones S.R.
Elshazly M.B.
Centro Johns Hopkins Ciccarone para la Prevención de las Enfermedades Cardiovasculares
Publisher(s)
Oxford University Press
Abstract
Aims: Emerging evidence suggests that remnant cholesterol (RC) promotes atherosclerotic cardiovascular disease (ASCVD). We aimed to estimate RC-related risk beyond low-density lipoprotein cholesterol (LDL-C) and apolipoprotein B (apoB) in patients without known ASCVD. Methods and results: We pooled data from 17 532 ASCVD-free individuals from the Atherosclerosis Risk in Communities study (n = 9748), the Multi-Ethnic Study of Atherosclerosis (n = 3049), and the Coronary Artery Risk Development in Young Adults (n = 4735). RC was calculated as non-high-density lipoprotein cholesterol (non-HDL-C) minus calculated LDL-C. Adjusted Cox models were used to estimate the risk for incident ASCVD associated with log RC levels. We also performed discordance analyses examining relative ASCVD risk in RC vs. LDL-C discordant/concordant groups using difference in percentile units (>10 units) and clinically relevant LDL-C targets. The mean age of participants was 52.3 ± 17.9 years, 56.7% were women and 34% black. There were 2143 ASCVD events over the median follow-up of 18.7 years. After multivariable adjustment including LDL-C and apoB, log RC was associated with higher ASCVD risk [hazard ratio (HR) 1.65, 95% confidence interval (CI) 1.45-1.89]. Moreover, the discordant high RC/low LDL-C group, but not the low RC/high LDL-C group, was associated with increased ASCVD risk compared to the concordant group (HR 1.21, 95% CI 1.08-1.34). Similar results were shown when examining discordance across clinical cutpoints. Conclusions: In ASCVD-free individuals, elevated RC levels were associated with ASCVD independent of traditional risk factors, LDL-C, and apoB levels. The mechanisms of RC association with ASCVD, surprisingly beyond apoB, and the potential value of targeted RC-lowering in primary prevention need to be further investigated.
Start page
4324
End page
4332
Volume
42
Issue
42
Language
English
OCDE Knowledge area
Sistema cardiaco, Sistema cardiovascular
Scopus EID
2-s2.0-85117166567
PubMed ID
Source
European Heart Journal
ISSN of the container
0195668X
Sources of information: Directorio de Producción Científica Scopus