Remnant cholesterol accumulation tied to risk for atherosclerosis
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Key takeaways:
- Both cumulative remnant cholesterol and remnant cholesterol variability independently predict atherosclerosis risk.
- The association was observed even among adults with optimal LDL.
Data show that higher cumulative remnant cholesterol and greater remnant cholesterol variability are each associated with elevated risk for atherosclerosis, independent of LDL, triglycerides level and other traditional CV risk factors.
“Remnant cholesterol represents the cholesterol content of triglyceride-rich lipoproteins, composed of intermediate-density lipoprotein and very-low-density lipoprotein in the fasting state, and in the nonfasting state with extra chylomicron remnants,” Lixin Tao, PhD, School of Public Health, Capital Medical University, Beijing, China, and colleagues wrote in the study background. “Remnant cholesterol is more abundant, bulky and carries more cholesterol than LDL particles, it may be trapped and accumulated on the arterial wall more easily, and thus may become more atherogenic.”
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Tao and colleagues analyzed data from 6,213 adults (53.5% men; median age, 46 years) who underwent three sequential health examinations between 2010 and 2015, with follow-up until Dec. 31, 2021. Researchers measured cumulative remnant cholesterol and remnant cholesterol variability across the three visits as well as carotid plaque and carotid intima-media thickness.
The findings were published in the Journal of the American Heart Association.
During a median follow-up of 4 years, 42.1% of participants developed atherosclerosis and 21.4% developed carotid plaque.
Higher cumulative remnant cholesterol was associated with elevated risk for carotid atherosclerosis (HR = 1.33; 95% CI, 1.17-1.52), as was greater remnant cholesterol variability (HR = 1.22; 95% CI, 1.08-1.39), with results persisting after factoring in LDL level and other traditional CV risk factors.
Researchers stratified participants according to median cumulative remnant cholesterol and remnant cholesterol variability to assess their joint associations. Compared with participants with low cumulative remnant cholesterol and low variability, those with high cumulative remnant cholesterol and high variability had the highest risk for carotid atherosclerosis, followed by those with high cumulative remnant cholesterol and low variability and low cumulative remnant cholesterol and high variability.
Additionally, joint assessment of remnant cholesterol accumulation and variability had the highest incremental effect on the predictive value of developing atherosclerosis vs. single-time-point measures of remnant cholesterol, according to the researchers.
The researchers noted that treatment strategies to reduce remnant cholesterol accumulation and its fluctuations might have the potential to prevent atherosclerosis-related diseases.
“Joint assessment of remnant cholesterol accumulation and variability may be useful for the risk stratification and primary prevention of atherosclerotic CVD, even in people with optimal LDL cholesterol levels,” the researchers wrote.
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