Elevated remnant cholesterol, but not LDL cholesterol, explains part of recurrent ASCVD events in individuals with and without impaired renal function: the Copenhagen General Population Study and the UK Biobank

AbstractBackground and aims Individuals with impaired renal function are at high risk of atherosclerotic cardiovascular disease (ASCVD). We hypothesized that elevated remnant cholesterol explains part of recurrent ASCVD event risk in individuals with and without impaired renal function. Methods We included 107,480 individuals from the Copenhagen General Population Study (CGPS) and 356,755 from the UK Biobank. Of these, 8,051 and 16,857 had ASCVD at baseline. Impaired renal function was defined as estimated glomerular filtration rate (eGFR)2 at baseline and remnant cholesterol was calculated from a standard lipid profile. Results In the CGPS and UK Biobank among those with ASCVD at baseline, 1,975 and 3,849 recurrent ASCVD events occurred. The hazard ratio for recurrent ASCVD events per 1 mmol/L (39 mg/dL) higher remnant cholesterol was 1.34 (95% CI: 1.19-1.51) in the CGPS and 1.51 (1.34-1.71) in the UK Biobank, with similar estimates in those with and without impaired renal function. LDL cholesterol was not associated with recurrent ASCVD events in either study. In the CGPS and the UK Biobank, remnant cholesterol explained 2.6% (95%CI: 1.3%-4.0%) and 2.7% (1.7%-3.7%) of the excess risk of recurrent ASCVD events in individuals with ASCVD at baseline. There was no interaction between remnant cholesterol and impaired renal function on the excess risk of ASCVD event in either study. Conclusions In individuals with ASCVD at baseline with and without impaired renal function, remnant cholesterol, but not LDL cholesterol, explained part of recurrent ASCVD event risk.