What is the clinical evidence from this study?

Study design: Cohort. Population: High cardiovascular risk (n=6901). Intervention: Remnant cholesterol vs. Lower concentrations. Primary outcome: Major adverse cardiovascular events (MACEs) (HR 1.21, 95% CI 1.10 to 1.33, p=<0.001).

What question did this study set out to answer?

To evaluate the association of circulating triglycerides and remnant cholesterol with major adverse cardiovascular events in older individuals at high cardiovascular risk.

September 6, 2026Journal of the American College of Cardiology

Remnant Cholesterol, Not LDL Cholesterol, Is Associated With Incident Cardiovascular Disease

Q: What are the key findings of this study?

Higher levels of remnant cholesterol were associated with an increased risk of major adverse cardiovascular events (HR 1.21; 95% CI 1.10-1.33 per 10 mg/dl; P<0.001), independent of LDL cholesterol.

Q: What question did this study set out to answer?

To evaluate the association of circulating triglycerides and remnant cholesterol with major adverse cardiovascular events in older individuals at high cardiovascular risk.

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Key result

Higher remnant cholesterol linked to ~21% greater MACE risk per 10 mg/dl.

HR 1.21
95% CI 1.10 to 1.33
P<0.001
n=6,901

Why the study?

Are higher levels of triglycerides and remnant cholesterol associated with increased risk of major adverse cardiovascular events in older individuals at high cardiovascular risk?

Population

6,901 older individuals at high cardiovascular risk from the primary prevention PREDIMED trial population…

Comparison

Higher levels of triglycerides and remnant… vs Lower levels of triglycerides and remnant…

Design

Cohort

Follow-up

median 4.8 years

Authors

OCOlga CastañerInstituto de Salud Carlos III XPXavier PintóPreventive Cardiology ISIsaac SubiranaInstitut d'Estadística de Catalunya

Discussion

Member takes

Implication

In overweight or obese subjects at high cardiovascular risk, remnant cholesterol and triglycerides, but not LDL-C, are independently associated with incident cardiovascular events.

Key Points

To evaluate the association of circulating triglycerides and remnant cholesterol with major adverse cardiovascular events in older individuals at high cardiovascular risk.
Evaluated baseline lipid profiles and tracked major adverse cardiovascular events (MACEs) in 6,901 participants from the PREDIMED trial (mean age: 67 years; BMI: 30 kg/m²; 43% men; 48% with diabetes).
Followed participants for a median duration of 4.8 years, during which 263 incident MACE cases occurred.
Applied unadjusted and multivariable-adjusted Cox proportional hazard models to evaluate associations between continuous and categorical lipid concentrations and incident MACEs.
Multivariable-adjusted analyses demonstrated that remnant cholesterol (HR: 1.21; 95% CI: 1.10 to 1.33 per 10 mg/dl; p < 0.001) and triglycerides (HR: 1.04; 95% CI: 1.02 to 1.06 per 10 mg/dl; p < 0.001) significantly predicted MACEs, whereas LDL-C and HDL-C did not.
Non-HDL-C (HR: 1.05; 95% CI: 1.01 to 1.10 per 10 mg/dl; p = 0.026) and atherogenic dyslipidemia (HR: 1.44; 95% CI: 1.04 to 2.00; p = 0.030) were also significantly associated with incident MACEs.
Remnant cholesterol levels ≥30 mg/dl differentiated individuals at higher risk of MACEs regardless of whether baseline LDL-C levels were at or below the target of 100 mg/dl.

Study Design

Type

Cohort (n=6,901)

Structured PICO

Are higher levels of triglycerides and remnant cholesterol associated with increased risk of major adverse cardiovascular events in older individuals at high cardiovascular risk?

Population

6,901 older individuals (mean age 67 years, 57% female) at high cardiovascular risk, followed for a median of 4.8 years.

Exposure

Higher levels of triglycerides and remnant cholesterol (remnant-C)

Comparator

Lower levels of triglycerides and remnant cholesterol

Outcome

Major adverse cardiovascular events (MACEs)composite

Main Result

Hazard Ratio: 1.21 (95% CI 1.1–1.33)

p-value: p=<0.001

In overweight or obese subjects at high cardiovascular risk, remnant cholesterol and triglycerides, but not LDL-C, are independently associated with incident cardiovascular events.

Cite This Study

Castañer et al. (2020) conducted a cohort in High cardiovascular risk (n=6,901). Remnant cholesterol vs. Lower concentrations was evaluated on Major adverse cardiovascular events (MACEs) (HR 1.21, 95% CI 1.10 to 1.33, p=<0.001). Higher levels of remnant cholesterol were associated with an increased risk of major adverse cardiovascular events (HR 1.21; 95% CI 1.10-1.33 per 10 mg/dl; P<0.001), independent of LDL cholesterol.

synapsesocial.com/papers/6a9d2ff15dbac097420019fc https://doi.org/10.1016/j.jacc.2020.10.008

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Implication

In overweight or obese subjects at high cardiovascular risk, remnant cholesterol and triglycerides, but not LDL-C, are independently associated with incident cardiovascular events.

Remnant Cholesterol, Not LDL Cholesterol, Is Associated With Incident Cardiovascular Disease

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Remnant Cholesterol, Not LDL Cholesterol, Is Associated With Incident Cardiovascular Disease

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Also Consider