Remnant Cholesterol, Not LDL Cholesterol, Is Associated With Incident Cardiovascular Disease
Open accessAbstract
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/m 2 ; 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 150 mg/dl [1.69 mmol/l] and HDL-C 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.
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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 [38]
Recent studies have suggested that triglycerides and remnant cholesterol may be more potent risk factors for myocardial infarction than LDL-C is.
“These studies have suggested that TG and remnant cholesterol may be more potent risk factors for myocardial infarction (MI) than LDL-C is.2,3”
From Association of Apolipoprotein B–Containing Lipoproteins and Risk of Myocardial Infarction in Individuals With and Without Atherosclerosis (2022) · cites this paper as [2]
Recent publications have reported that TG, rather than LDL-C, most strongly predict CV risk.
“These findings are of increased relevance as recent publications have reported that TG, rather than LDL-C, most strongly predict CV risk.2”
From Association of Apolipoprotein B–Containing Lipoproteins and Risk of Myocardial Infarction in Individuals With and Without Atherosclerosis (2022) · cites this paper as [2]
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- Authors
- Castañer, O., Pintó, X., Subirana, I., Amor, A. J., Ros, E., Hernáez, Á., Martínez-González, M. Á., Corella, D., Salas-Salvadó, J., Estruch, R., Lapetra, J., Gómez-Gracia, E., Alonso-Gomez, A. M., Fiol, M., Serra-Majem, L., Corbella, E., Benaiges, D., Sorli, J. V., Ruiz-Canela, M., Babió, N., Sierra, L. T., Ortega, E., & Fitó, M.
- Affiliations
- Instituto de Salud Carlos III (ES)
- Universitat de València (ES)
- University of the Basque Country (ES)
- Hospital Del Mar (ES)
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2020-12
- Volume
- 76
- Issue
- 23
- Pages
- 2712-2724
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W3107163014
- Cited by
- 540
- References
- 17
- Citations by year
- 2026: 76 · 2025: 101 · 2024: 124 · 2023: 110 · 2022: 72 · 2021: 55 · 2020: 1
- FWCI
- 54.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Acceda (Universidad de Las Palmas de Gran Canaria) (submittedVersion)
- Repository of Digital Objects for Teaching Research and Culture (University of Valencia) (submittedVersion)
- Funders
- Instituto de Salud Carlos III
- 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 › Lipid metabolism and disorders
- Keywords
- remnant cholesterol, triglycerides, non-HDL cholesterol, LDL cholesterol, major adverse cardiovascular events, atherogenic dyslipidemia, cardiovascular risk, older adults, high cardiovascular risk, triglyceride-rich lipoproteins, HDL cholesterol, cardiovascular disease prevention, diabetes mellitus, sex differences in cardiovascular risk, cardiovascular risk stratification
- MeSH terms
- Aged, Cardiovascular Diseases, Cholesterol, Female, Humans, Lipoproteins, Male, Middle Aged, Risk Factors, Triglycerides, Cohort Studies, Body Mass Index, Proportional Hazards Models, Diet, Mediterranean
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