Remnant cholesterol, low-density lipoprotein cholesterol, and incident cardiovascular disease among Koreans: a national population-based study

Abstract

Background and Aims The synergistic association of remnant cholesterol (remnant-C) and low-density lipoprotein cholesterol (LDL-C) levels with incident cardiovascular disease (CVD) in various subgroups of Koreans was investigated. Methods Using the national health insurance data, we included subjects aged between 40 and 70 without a history of CVD and at least two health screenings between 2009 and 2011. The subjects were divided into four groups by LDL-C and remnant-C levels. The primary outcome was CVD, which occurred between 2014 and 2017. Results Among 3,686,034 (45.6% women) of subjects, 144,004 cardiovascular events occurred. Individuals in both high LDL-C and high remnant-C [hazard ratio (HR) 1.266, 95% confidence interval (CI) 1.243–1.289; 7.9%], high LDL-C only (HR 1.098, 95% CI 1.083–1.113; 21.2%), and high remnant-C only groups (HR 1.102, 95% CI 1.087–1.118; 19.1%) had higher risks of CVD than the reference group (LDL-C < 3.4 mmol/L and remnant-C < 0.8 mmol/L; 51.8%). A continuous and linear increase in CVD risk was found in those with higher remnant-C levels after adjustment for several confounders, including LDL-C levels. The association of remnant-C ≥ 0.8 mmol/L with an increased CVD risk was consistent across various strata. Conclusions Combined high remnant-C and LDL-C levels confer a higher CVD risk than that individually. Elevated remnant-C values, independent of LDL-C levels, were associated with a risk of incident CVD. Remnant-C levels in addition to LDL-C levels are important considerations in risk stratification for the primary prevention of CVD.

Remnant cholesterol and low-grade inflammation jointly in atherosclerotic cardiovascular disease: implications for clinical trials

“…Overall, the results of recently published observational and genetic Mendelian randomization studies support a causal association between elevated remnant cholesterol and ASCVD (Table 1) [20 ▪▪ ,22 ▪▪ ,23–25,26 ▪ –28 ▪ ,29–32,33 ▪ ,34–39]. Furthermore, the results imply that remnant particles have a substantially greater per particle atherogenicity than LDL, most probably because remnants per particle carry substantially more cholesterol than LDL [20 ▪▪ ,21] (Fig.…”

Triglyceride-Rich Lipoproteins and Remnant Cholesterol in Cardiovascular Disease

“…According to Huh et al, 14 elevated levels of remnant cholesterol (≥ 30 mg/dL) are associated with CVD incidence in adults with type 2 diabetes, independent of LDL-C levels. Lee et al 15 have likewise demonstrated an association between calculated fasting remnant cholesterol and ischemic heart disease or stroke in previously asymptomatic South Korean subjects.…”

Remnant cholesterol as a new lipid-lowering target to reduce cardiovascular events

“…Using the Korean National Health Insurance Service database of 1 956 452 patients with type 2 diabetes mellitus without prior cardiovascular disease, Huh et al [22] showed a 22–28% increased risk of ischemic stroke and MI in patients in the top quartile of remnant cholesterol compared to the lowest quartile. In a subsequent publication from the same database, Lee et al [23 ▪▪ ] focused on a general population of 3 686 034 individuals (45.6% women), and confirmed the association of remnant cholesterol with cardiovascular events independent of LDL-C or other conventional risk factors.…”