Remnant Cholesterol, Not LDL Cholesterol, Is Associated With Incident Cardiovascular Disease.

Abstract

BACKGROUND:

Genetic, observational, and clinical intervention studies indicate that circulating levels of triglycerides and cholesterol transported in triglyceride-rich lipoproteins (remnant cholesterol) can predict cardiovascular events.

OBJECTIVES:

This study evaluated the association of triglycerides and remnant cholesterol (remnant-C) with major cardiovascular events in a cohort of older individuals at high cardiovascular risk.

METHODS:

This study determined the baseline lipid profile and searched for major adverse cardiovascular events (MACEs) in the high-risk primary prevention PREDIMED (Prevención con Dieta Mediterránea) trial population (mean age: 67 years; body mass index: 30 kg/m2; 43% men; 48% with diabetes) after a median follow-up of 4.8 years. Unadjusted and adjusted Cox proportional hazard models were used to assess the association between lipid concentrations (either as continuous or categorical variables) and incident MACEs (N = 6,901; n cases = 263).

RESULTS:

In multivariable-adjusted analyses, triglycerides (hazard ratio [HR]: 1.04; 95% confidence interval [CI]: 1.02 to 1.06, per 10 mg/dl [0.11 mmol/l]; p < 0.001), non-high-density lipoprotein cholesterol (HDL-C) (HR: 1.05; 95% CI: 1.01 to 1.10, per 10 mg/dl [0.26 mmol/l]; p = 0.026), and remnant-C (HR: 1.21; 95% CI: 1.10 to 1.33, per 10 mg/dl [0.26 mmol/l]; p < 0.001), but not low-density lipoprotein cholesterol (LDL-C) or HDL-C, were associated with MACEs. Atherogenic dyslipidemia (triglycerides >150 mg/dl [1.69 mmol/l] and HDL-C <40 mg/dl [1.03 mmol/l] in men or <50 mg/dl [1.29 mmol/l] in women) was also associated with MACEs (HR: 1.44; 95% CI: 1.04 to 2.00; p = 0.030). Remnant-C ≥30 mg/dl (0.78 mmol/l) differentiated subjects at a higher risk of MACEs compared with those at lower concentrations, regardless of whether LDL-C levels were on target at ≤100 mg/dl (2.59 mmol/l).

CONCLUSIONS:

In overweight or obese subjects at high cardiovascular risk, levels of triglycerides and remnant-C, but not LDL-C, were associated with cardiovascular outcomes independent of other risk factors.

• Authors: Olga Castañer, Xavier Pintó, Isaac Subirana, Antonio J Amor, Emilio Ros, Álvaro Hernáez, Miguel Ángel Martínez-González, Dolores Corella, Jordi Salas-Salvadó, Ramón Estruch, José Lapetra, Enrique Gómez-Gracia, Angel M Alonso-Gomez, Miquel Fiol, Lluís Serra-Majem, Emili Corbella, David Benaiges, Jose V Sorli, Miguel Ruiz-Canela, Nancy Babió, Lucas Tojal Sierra, Emilio Ortega, Montserrat Fitó
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 76 Issue 23 Pg. 2712-2724 (12 08 2020) ISSN: 1558-3597 [Electronic] United States
• PMID: 33272365 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2020. Published by Elsevier Inc.

Chemical References

• Lipoproteins
• Triglycerides
• lipoprotein triglyceride
• Cholesterol

Topics

• Aged
• Body Mass Index
• Cardiovascular Diseases (blood, epidemiology, prevention & control)
• Cholesterol (blood)
• Cohort Studies
• Diet, Mediterranean
• Female
• Humans
• Lipoproteins (blood)
• Male
• Middle Aged
• Proportional Hazards Models
• Risk Factors
• Triglycerides (blood)