Remnant cholesterol may be an independent risk factor for ASCVD progression
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The level of total cholesterol minus HDL and LDL was associated with progression of atherosclerosis, independently of traditional CV risk factors, according to data published in Circulation: Cardiovascular Imaging.
Using data from the CARDIA and MESA prospective studies, researchers evaluated the relationship between remnant cholesterol and risk for coronary artery calcium progression.
“There is apparent residual atherosclerotic cardiovascular disease risk in individuals with traditionally optimal LDL cholesterol levels,” Qing-Yun Hao, MD, of the department of cardiology at Sun Yat-sen Memorial Hospital, Sun Yat-sen University in Guangzhou, China, and colleagues wrote. “Our results demonstrate that elevated remnant cholesterol levels are associated with a higher risk of coronary artery calcium progression in later life.”
Remnant cholesterol was defined as total cholesterol minus HDL and LDL estimated by using the Martin/Hopkins equation.
The analysis included 6,544 individuals free from ASCVD at baseline who were followed for more than 8 years (mean age, 47 years; 46% men).
After adjustment for demographics and traditional CV risk factors, researchers observed a 1.3% increase in risk for CAC progression for every 1 mg/dL increase in remnant cholesterol (adjusted HR = 1.013; 95% CI, 1.008-1.017). Findings were similar across varying levels of remnant cholesterol.
Moreover, study participants with discordant high remnant cholesterol and low LDL — defined as LDL below 100 mg/dL and 130 mg/dL in two separate analyses — experienced greater risk for CAC progression compared with those with concordant low remnant cholesterol and LDL (HR = 1.195; 95% CI, 1.063-1.343); however, risk was not different when researchers used a cutoff of 70 mg/dL to define low LDL.
“A high remnant cholesterol/low LDL cholesterol discordance has a significantly higher risk of coronary artery calcium progression, which is substantially attenuated when the optimal LDL cholesterol cut points are more rigorous (< 70 mg/dL),” the researchers wrote. “Novel therapies targeting remnant cholesterol are expected with the aim to attenuate subclinical atherosclerosis and to further reduce atherosclerotic cardiovascular disease risk in the contemporary era of statin therapy.”
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