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Cited by 19Lipoproteins and Cardiovascular HealthDiabetes, Cardiovascular Risks, and LipoproteinsAcute Myocardial Infarction Research

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

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Drexel, Heinz, Mader, Arthur, Larcher, Barbara, Festa, Andreas, Vonbank, Alexander, Fraunberger, Peter, Leiherer, Andreas, Saely, Christoph H.·2025·Atherosclerosis
DOI 10.1016/j.atherosclerosis.2024.119048
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Abstract

Background 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. Methods 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. Results 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. Conclusions From our data we conclude that RC is associated with future all-cause mortality, cardiovascular mortality and MACE i…

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  • Observational cohorts demonstrate that higher TG and remnant cholesterol predict cardiovascular events independently of LDL-C.

    “Observational cohorts demonstrate that higher TG and remnant cholesterol predict cardiovascular events independently of LDL-C, while Mendelian randomization analyses confirm a causal relationship between lifelong TRL elevation and ASCVD.”

    From Targeting triglycerides for cardiovascular risk reduction (2026) · cites this paper as [41]

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Authors
Drexel, H., Mader, A., Larcher, B., Festa, A., Vonbank, A., Fraunberger, P., Leiherer, A., & Saely, C. H.
Affiliations
  • Private University in the Principality of Liechtenstein (LI)
  • Landeskrankenhaus Feldkirch (AT)
Corresponding author
Drexel, Heinz
ORCID
Venue
Atherosclerosis
Publisher
Elsevier BV
Published
2025-02
Volume
401
Pages
119048
ISSN
0021-9150 (ISSN-L)
DOI
10.1016/j.atherosclerosis.2024.119048
OpenAlex
W4404437443
Cited by
17
References
54
Citations by year
2026: 9 · 2025: 8
FWCI
7.12
Type
journal article
Language
en
Open access
Licence
Locations
  • Atherosclerosis (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
Keywords
remnant cholesterol, coronary artery disease, all-cause mortality, cardiovascular mortality, major adverse cardiovascular events, residual cardiovascular risk, non-HDL cholesterol, LDL cholesterol, statin therapy, long-term prognosis
MeSH terms
Aged, Cause of Death, Cholesterol, Coronary Artery Disease, Female, Humans, Lipoproteins, Cholesterol, LDL, Male, Middle Aged, Prospective Studies, Risk Factors, Time Factors, Triglycerides, Biomarkers, Incidence, Proportional Hazards Models, Coronary Angiography, Risk Assessment

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