Key result
Higher remnant cholesterol linked to ~36% higher ASCVD risk in CKD.
Why the study?
Is higher remnant cholesterol independently associated with atherosclerotic cardiovascular disease events in patients with chronic kidney disease?
Meta-Analysis (n=110,000)
Yes
Is higher remnant cholesterol independently associated with atherosclerotic cardiovascular disease events in patients with chronic kidney disease?
In patients with chronic kidney disease, higher remnant cholesterol is independently associated with an increased risk of atherosclerotic cardiovascular events, independent of LDL-C or apolipoprotein B.
Answers are grounded in this paper and cite their sources.
May flag residual ASCVD risk in CKD beyond LDL-C; leaves open whether targeting remnant cholesterol improves outcomes.
Chronic kidney disease (CKD) carries residual atherosclerotic risk despite low-density lipoprotein cholesterol (LDL-C)-directed therapy. Remnant cholesterol is a candidate residual-risk marker, but its prognostic value in CKD is undefined. The objectives of this study were to determine whether higher remnant cholesterol is independently associated with atherosclerotic cardiovascular disease events in CKD, and whether this holds across exposure construct, LDL-C adjustment, and region. In this PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) 2020 review, we searched 8 databases from inception to June 2026 for longitudinal studies of remnant cholesterol and cardiovascular outcomes in CKD. Screening, extraction, QUIPS (Quality In Prognosis Studies) risk of bias, and GRADE (Grading of Recommendations Assessment, Development and Evaluation) were duplicated. Adjusted hazard ratios were pooled by random-effects meta-analysis within outcome × scale strata. Eighteen cohorts (approximately 110,000 participants; follow-up, 1.8-13.8 years) were included. Remnant cholesterol was associated with atherosclerotic cardiovascular disease (HR: 1.36; 95% CI: 1.24-1.49; P = 0.0007; I2 = 0%; k = 5) highest-versus-lowest, and (HR: 1.27; 95% CI: 1.12-1.45; k = 3) per 1 mmol/L. It was independent of LDL-C/apolipoprotein B adjustment, carried by remnant rather than very-low-density lipoprotein cholesterol (q = 0.021), consistent across regions, robust in Asian cohorts (HR: 1.38; 95% CI: 1.19-1.59; I2 = 0%; k = 4) and concordant in non-Asian cohorts (HR: 1.21; 95% CI: 1.04-1.41; k = 5), and stable across every sensitivity analysis (GRADE certainty: moderate). In CKD, higher remnant cholesterol is independently associated with atherosclerotic cardiovascular events (moderate certainty), supporting it as a candidate residual-risk marker and therapeutic hypothesis. Registration Remnant Cholesterol and Cardiovascular Outcomes in Chronic Kidney Disease: A Systematic Review and Meta-analysis of Prognostic Evidence; PROSPERO CRD420261428689.
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Tripathi et al. (2026) conducted a meta-analysis in Chronic kidney disease (n=110,000). Higher remnant cholesterol vs. Lowest remnant cholesterol was evaluated on Atherosclerotic cardiovascular disease events (HR 1.36, 95% CI 1.24-1.49, p=0.0007). Higher remnant cholesterol was independently associated with increased atherosclerotic cardiovascular disease risk in CKD.
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