Abstract Introduction Remnant cholesterol (RC) represents the cholesterol content of ApoB48- and ApoB100-containing atherogenic triglyceride-rich lipoproteins, such as chylomicrons, very-low-density lipoproteins (VLDL), and intermediate-density lipoproteins (IDL) and is calculated as total cholesterol minus low-density lipoprotein cholesterol (LDL-C) minus high-density lipoprotein cholesterol (HDL-C). RC has gained attention as a marker for cardiovascular event risk and mortality. Purpose The purpose of the study was to investigate whether RC predicts all-cause mortality in patients with established coronary artery disease, independent of the total ApoB particle count. Methods We included 1,481 patients with angiographically confirmed coronary artery disease. The mean age was 65.1 ± 10.4 years, 415 (28%) of the patients were female. The mean follow-up period was 11.3 ± 5.1 years. Results During follow-up, 52.2% (n=773) of our patients died. At baseline, the mean RC level was 23 ± 23 mg/dL, and the mean ApoB level was 96 ± 29 mg/dL. A Cox regression model demonstrated that RC was a significant predictor of all-cause mortality after adjustment for age, smoking, LDL-C, HDL-C, hypertension, type 2 diabetes, BMI, and also ApoB, with a hazard ratio (HR) for all-cause mortality of 1.14 (95% CI: 1.01–1.27, p=0.028). In contrast, ApoB was not associated with all-cause mortality after adjustment for RC (HR 0.998, 95% CI: 0.793–1.13, p=0.524). Conclusion We conclude that RC is an independent predictor of all-cause mortality, irrespective of the ApoB particle count. This finding underscores the atherogenic significance of the cholesterol content, rather than the ApoB particle count, of triglyceride-rich lipoproteins.
MADER et al. (Sat,) studied this question.