Key result
Elevated LDL-C plus remnant cholesterol is linked to ~2.2-fold higher major cardiovascular events risk.
Why the study?
Residual cardiovascular risk persists in elderly hypertensive patients despite controlled LDL-C, and evidence for the combined prognostic value of LDL-C and remnant cholesterol in this population is limited.
Does combined assessment of elevated baseline remnant cholesterol (≥ 0.62 mmol/L) and LDL-C (≥ 2.6 mmol/L) predict a higher risk of major adverse cardiovascular events compared to low LDL-C and low remnant cholesterol in elderly hypertensive patients?
Cohort (n=847)
Blinded outcome adjudication
No
Does combined assessment of elevated baseline remnant cholesterol (≥ 0.62 mmol/L) and LDL-C (≥ 2.6 mmol/L) predict a higher risk of major adverse cardiovascular events compared to low LDL-C and low remnant cholesterol in elderly hypertensive patients?
Combined stratification of remnant cholesterol and LDL-C identifies elderly hypertensive patients at heightened residual risk for major adverse cardiovascular events, particularly when both markers are elevated.
Answers are grounded in this paper and cite their sources.
Concurrent elevations may identify higher MACE risk in elderly hypertensives; hypothesis-generating and leaves open whether targeting remnant cholesterol improves outcomes.
Residual cardiovascular risk remains in elderly hypertensive patients with LDL-C controlled LDL-C. Remnant cholesterol (RC) is associated with atherosclerotic cardiovascular disease, but evidence for the combined prognostic value of LDL-C and RC in elderly hypertensive patients is limited. This retrospective cohort study initially enrolled 871 elderly hypertensive patients admitted between January 2020 and December 2022 from Wuyi County Traditional Chinese Medicine Hospital; 847 patients completed follow-up and were included in outcome analysis, while 24 patients were lost to follow-up throughout the observational period. Patients were divided into four groups by baseline LDL-C (< 2.6 vs. ≥ 2.6 mmol/L) and RC (< 0.62 vs. ≥ 0.62 mmol/L). The primary endpoint was major adverse cardiovascular events (MACE). Multivariate Cox regression, Kaplan–Meier and subgroup analyses were performed. During a median 36-month follow-up, 23.3% (197/847) patients had MACE. The incidence increased stepwise: 14.4% (low LDL-C + low RC), 20.3% (high LDL-C + low RC), 25.6% (low LDL-C+high RC), 33.6% (high LDL-C+high RC) ( P < 0.001). In multivariate Cox regression analysis, baseline remnant cholesterol (RC) was associated with MACE (HR = 1.451, 95%CI 1.071–1.967, P = 0.016), whereas baseline LDL-C showed only a marginal association without statistical significance (HR = 1.197, 95%CI 0.983–1.459, P = 0.074). Elevated BNP also predicted MACE (HR = 1.004, 95%CI 1.001–1.008, P = 0.021). Compared with low LDL-C + low RC group, adjusted HRs were 1.401 ( P = 0.021), 1.755 ( P = 0.003) and 2.248 ( P = 0.002) in the other three groups respectively. Stratification based on LDL-C and RC levels identifies subgroups with distinct MACE risk among elderly hypertensive patients; patients with concurrent elevation of both lipids exhibited the highest cardiovascular event risk. Combined assessment of LDL-C and remnant cholesterol may help identify patients at higher MACE risk among elderly hypertensive individuals.
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Chen et al. (2026) conducted a cohort in Elderly hypertension (n=847). High LDL-C (≥2.6 mmol/L) combined with high remnant cholesterol (≥0.62 mmol/L) vs. Low LDL-C (<2.6 mmol/L) combined with low remnant cholesterol (<0.62 mmol/L) was evaluated on Major adverse cardiovascular events (MACE: composite of non-fatal acute coronary syndrome, non-fatal acute heart failure, non-fatal stroke, and cardiovascular mortality) (HR 2.248, 95% CI 1.335-3.802, p=0.002). Concurrent elevation of LDL-C and remnant cholesterol more than doubled major cardiovascular events risk compared with low levels of both lipids.
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