Remnant Lipoproteins Are Residual Risk Factor for Future Cardiovascular Events in Patients With Stable Coronary Artery Disease and On-Statin Low-Density Lipoprotein Cholesterol Levels <70 mg/dL

Abstract

Background: This study examined the predictive value of remnant lipoprotein levels for cardiovascular events (CVEs) in patients with stable coronary artery disease (CAD) and low-density lipoprotein cholesterol (LDL-C) levels <70 mg/dL on statin treatment. Methods and Results: Serum levels of remnant lipoproteins (remnant-like lipoprotein particles cholesterol: RLP-C) were measured by an immunoseparation method in 247 consecutive patients with CAD who had on-statin LDL-C levels <70 mg/dL. All the patients were followed prospectively for a period of ≤60 months or until the occurrence of the primary composite endpoint of cardiac death, nonfatal myocardial infarction, unstable angina requiring coronary revascularization, worsening heart failure, peripheral artery disease, aortic event, and ischemic stroke. During a mean follow-up period of 38 months, 33 CVEs occurred. Kaplan-Meier analysis demonstrated that higher RLP-C levels (≥3.9 mg/dL, determined by ROC curve) resulted in a significantly higher probability for the primary endpoint than did lower RLP-C levels (<3.9 mg/dL) (P<0.01 by log-rank test). Stepwise multivariate Cox proportional hazard analysis showed that RLP-C was a significant predictor of the primary endpoint after adjustment for known risk factors and lipid variables including triglycerides, and total apolipoprotein B (hazard ratio 1.62, 95% confidence interval 1.26-2.07, P<0.01). Conclusions: RLP-C levels are a residual risk factor for future CVEs in patients with CAD and on-statin LDL-C <70 mg/dL.

Prognostic Impact of Remnant-like Particle Cholesterol in Patients with Differing Glucose Metabolic Status: an Observational Cohort Study from China

“…In this study, LDL-C level did not show predictive value for poor prognosis, which is consistent with previous studies [5,13,29]. The underlying causes can be complex.…”

“…In recent years, factors related to obesity and metabolic syndrome such as triglycerides rich lipoproteins (TRLs) have been considered as potential metabolism-related risk factors for cardiovascular diseases and the cause of residual risks other than LDL-C. As the cholesterol component of the subset of TRLs, RLP-C has been demonstrated to be a causal risk factor for ischemic heart disease (IHD) [23][24][25]. Clinical studies also revealed that higher RLP-C levels showed favorable predictive value for the risk of recurrent cardiovascular events in patients with either stable coronary artery disease (SCAD) or ACS, regardless of the baseline treatment of statins and level of LDL-C [12,[26][27][28][29]. The current analyses extend these ndings to a cohort of patients with NSTE-ACS treated with PCI and indicates that elevated RLP-C is signi cantly associated with adverse prognosis.…”

Prognostic Impact of Estimated Remnant-like Particle Cholesterol in Patients with Differing Glycometabolic Status: an Observational Cohort Study from China

“…In recent years, factors related to obesity and metabolic syndrome, such as triglycerides rich lipoproteins (TRLs), have been considered as potential metabolism-related risk factors for cardiovascular diseases and possible cause of residual risks other than LDL-C. As the cholesterol component of the subset of TRLs, RLP-C has been demonstrated to be a causal risk factor of coronary artery disease (CAD) [23][24][25]. Previous studies also revealed that higher RLP-C levels showed favorable predictive value for adverse prognosis, either in those with stable CAD or ACS, regardless of the baseline treatment of statins and level of LDL-C [12,[26][27][28][29].…”

Prognostic Impact of Remnant-like Particle Cholesterol in Patients with Differing Glucose Metabolic Status: an Observational Cohort Study from China

“…In recent years, factors related to obesity and metabolic syndrome, such as triglycerides rich lipoproteins (TRLs), have been considered as potential metabolism-related risk factors for cardiovascular diseases and a possible cause of residual risks other than LDL-C. As the cholesterol component of the subset of TRLs, RLP-C has been demonstrated to be a causal risk factor for ischemic heart disease (IHD) [23][24][25]. Clinical studies also revealed that higher RLP-C levels showed favorable predictive value for the risk of recurrent cardiovascular events in patients with either stable coronary artery disease (SCAD) or ACS, regardless of the baseline treatment of statins and level of LDL-C [12,[26][27][28][29]. The current analyses extend these ndings to a cohort of patients with NSTE-ACS treated with PCI and indicate that elevated RLP-C is signi cantly associated with adverse prognosis.…”