Key result
Elevated remnant cholesterol is linked to modestly increased risk of CAD and future cardiovascular events.
Why the study?
Remnant cholesterol reflects the cholesterol content of triglyceride-rich lipoproteins and is strongly associated with subclinical inflammation and endothelial dysfunction. This study aimed to determine whether remnant cholesterol is independently associated with CAD and future CV events beyond traditional risk factors in a coronary population.
Is elevated remnant cholesterol independently associated with coronary artery disease and future cardiovascular events in a coronary population?
Case-Control (n=3,157)
Is elevated remnant cholesterol independently associated with coronary artery disease and future cardiovascular events in a coronary population?
Elevated remnant cholesterol is independently associated with both prevalent coronary artery disease and long-term cardiovascular events beyond traditional risk factors.
Remnant cholesterol may refine CAD risk estimation; leaves open its utility in clinical practice pending prospective data.
Introduction Remnant cholesterol (RC) is a proven independent and causal risk factor for coronary artery disease (CAD), beyond LDL-C, HDL-C, triglycerides, diabetes, and other traditional risk factors. It reflects the cholesterol content of triglyceride-rich lipoproteins and is strongly associated with subclinical inflammation and endothelial dysfunction. Objective Determine whether remnant cholesterol is independently associated with CAD in a coronary population. Methods A case-control study performed between 2000 and 2023 included 1,722 successive coronary patients (mean age 53.3±7.9 years, 78.8% male) and 1,435 controls (mean age 52.7±7.8 years, 76.2% male). RC was calculated by the formula: total cholesterol - (LDL-C + HDL-C) (mmol/L) and categorised as below or above the median. Multivariate logistic regression was performed to assess the association between RC and CAD, adjusting for age, sex, smoking, physical inactivity, type 2 diabetes, hypertension, body mass index, alcohol consumption, and chronic kidney disease. Patients were prospectively followed for an extended period (median 7.6±6.7 years), and an adjusted Cox regression analysis was applied to identify independent predictors of cardiovascular (CV) events. Results The median RC value was 26.4 (19.0-39.0), and this value was used in the statistical analyses. Multivariate logistic regression showed that RC remained independently associated with CAD (OR=1.004; CI95%-1.001-1.008; p=0.023), together with smoking, type 2 diabetes, physical inactivity and chronic kidney disease (all p<0.0001). During the follow-up, 715 CV events were recorded. Cox regression showed that RC is independently associated with CV events (HR=1.004; 95% CI 1.001-1.007; p=0.005), together with age (p=0.045); sedentary lifestyle (p<0.0001) and diabetes (p=0.047). Conclusion Elevated RC was associated with CAD and long-term CV events, independently of major traditional risk factors. These findings underscore the potential value of targeted RC reduction, which may refine lipid risk profiles and reduce the burden of coronary disease.Remanant cholesterol
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Sousa et al. (2026) conducted a case-control in Coronary artery disease (n=3,157). Remnant cholesterol (RC) vs. Remnant cholesterol below the median (<26.4) / non-CAD controls was evaluated on Coronary artery disease (CAD) and long-term cardiovascular (CV) events (OR 1.004, 95% CI 1.001-1.008, p=0.023). Elevated remnant cholesterol was independently associated with coronary artery disease (OR 1.004; 95% CI 1.001-1.008; p=0.023) and future CV events (HR 1.004; 95% CI 1.001-1.007; p=0.005).
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