Key result
Elevated LDL-C and remnant-C post-revascularization linked to ~15% higher MACCE risk.
Why the study?
Residual cardiovascular risk persists despite LDL-C control in CAD, and the clinical impact of combined LDL-C and remnant cholesterol phenotypes after coronary revascularization required evaluation.
Does the combination of elevated LDL cholesterol and/or remnant cholesterol phenotypes increase the risk of major adverse cardiovascular and cerebrovascular events compared to low levels of both in patients who underwent coronary revascularization?
Cohort (n=63,119)
Yes
Does the combination of elevated LDL cholesterol and/or remnant cholesterol phenotypes increase the risk of major adverse cardiovascular and cerebrovascular events compared to low levels of both in patients who underwent coronary revascularization?
Elevated remnant cholesterol identifies patients at persistent residual cardiovascular risk after coronary revascularization, even when LDL cholesterol is controlled below 70 mg/dL.
Background Low-density lipoprotein cholesterol (LDL-C) is a primary therapeutic target in coronary artery disease (CAD); however, residual cardiovascular risk persists despite LDL-C control. Remnant cholesterol (remnant-C) has emerged as a potential contributor to this residual risk. Purpose To evaluate clinical outcomes according to combined LDL-C and remnant-C phenotypes in patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). Methods Using the National Health Insurance Service (NHIS) database, we identified 63,119 patients who underwent underwent PCI or CABG between 2011 and 2020. Patients were stratified into four groups according to LDL-C (cut-off 70 mg/dL) and remnant-C (cut-off 22.5 mg/dL): Group 1 (both low), Group 2 (low LDL-C/High remnant-C), Group 3 (high LDL-C/low remnant-C), and group 4 (both high). The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), defined as cardiovascular death, myocardial infarction, repeat revascularization, or non-fatal stroke. Multivariable Cox models sequentially adjusted for demographic factors, comorbidities, lipid-lowering therapy, and antithrombotic medications. Results During follow-up, group 4 demonstrated the highest risk of MACCE compared with group 1 (adjusted hazard ratio [HR] 1.15; 95% confidence interval [CI] 1.11–1.20; p<0.001). Notably, patients with controlled LDL-C but elevated remnant-C (group 2) remained at increased risk (HR 1.07; 95% CI 1.03-1.12; p<0.001), whereas those with elevated LDL-C but low remnant-C (group 3) showed only modest risk elevation (HR 1.05; 95% CI 1.01-1.09; p=0.024). Elevated remnant-C was consistently associated with myocardial infarction, stroke, and repeat revascularization. Conclusions Remnant-C provides incremental prognostic value beyond LDL-C in patients undergoing coronary revascularization. Even when LDL-C is well controlled, elevated remnant-C identifies patients at persistent residual cardiovascular risk.Cubic Spline CurvesMACCEs
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Jeon et al. (2026) conducted a cohort in Coronary artery disease undergoing coronary revascularization (PCI or CABG) (n=63,119). Combined high LDL-C (≥70 mg/dL) and high remnant-C (≥22.5 mg/dL) phenotype (Group 4) vs. Low LDL-C (<70 mg/dL) and low remnant-C (<22.5 mg/dL) phenotype (Group 1) was evaluated on Major adverse cardiovascular and cerebrovascular events (MACCE: cardiovascular death, myocardial infarction, repeat revascularization, or non-fatal stroke) (HR 1.15, 95% CI 1.11-1.20, p=<0.001). Elevated LDL-C and remnant-C after coronary revascularization increased MACCE risk vs low levels of both (HR 1.15; 95% CI 1.11-1.20; p<0.001), as did isolated high remnant-C (HR 1.07; p<0.001).
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