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Remnant cholesterol and long-term incidence of death in coronary artery disease patients
Journal article   Peer reviewed

Remnant cholesterol and long-term incidence of death in coronary artery disease patients

Heinz Drexel, Arthur Mader, Barbara Larcher, Andreas Festa, Alexander Vonbank, Peter Fraunberger, Andreas Leiherer and Christoph H. Saely
Atherosclerosis, v 401, p119048
01 Feb 2025
PMID: 39632214

Abstract

All-cause mortality Cardiovascular mortality Coronary heart disease Lipoproteins Major adverse cardiovascular events Prospective study Remnant cholesterol
Remnant cholesterol (RC), defined as non-HDL-non-LDL cholesterol, has attracted recent scientific interest as a candidate lipid factor for residual cardiovascular risk. Despite a rising amount of epidemiologic information, there are imprecisions because most available data arise from non-fasting, frozen and calculated values. We enrolled 1474 consecutive patients with angiographically proven CAD, and measured RC in strictly fasting, non-frozen samples with a direct assay for LDL-C. Prospectively, all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events (MACE) were recorded over a mean follow-up period of 11.6 ± 5.0 years, covering 17098 patient years. During follow-up, CAD patients had a rate of all-cause mortality of 52.2 % (n = 769), of cardiovascular mortality of 20.6 % (n = 303), and an incidence of major adverse cardiovascular events (MACE) of 39.1 % (n = 576). Prospectively, RC was associated with all-cause mortality (HR 1.12 [1.03–1.23], p = 0.009), cardiovascular mortality (HR 1.20 [1.06–1.36], p = 0.005), and MACE (HR 1.10 [1.01–1.21], p = 0.033) in Cox regression analyses across various levels of adjustment (age, sex, smoking, LDL-C, HDL-C, hypertension, T2DM, and BMI). Findings did not differ between women and men. Furthermore, there was no discernible influence of statin treatment. From our data we conclude that RC is associated with future all-cause mortality, cardiovascular mortality and MACE in patients with established coronary artery disease. Proper pre-analytic and analytic methods provided, RC represents a reliable indicator of residual risk. [Display omitted] •Remnant cholesterol (RC) links to severe outcomes: all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events (MACE).•Findings on RC are novel in the field of coronary artery disease patients.•Robust methodology: large cohort, long observation period, precise lipid measurements, meticulous sample handling.

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Collaboration types
International collaboration
Web of Science research areas
Cardiac & Cardiovascular Systems
Peripheral Vascular Disease
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