Elevated Remnant Cholesterol Reclassifies Risk of Ischemic Heart Disease and Myocardial Infarction
Open accessAbstract
Background Elevated remnant cholesterol causes ischemic heart disease. Objectives We tested the hypothesis that the inclusion of elevated remnant cholesterol will lead to appropriate reclassification of individuals who later experience myocardial infarction and ischemic heart disease. Methods For >10 years we followed up 41,928 white Danish individuals from the Copenhagen General Population Study without a history of ischemic cardiovascular disease, diabetes, and statin use. Using predefined cut points for elevated remnant cholesterol, we calculated net reclassification index (NRI) from below to above 5%, 7.5%, and/or 10% 10-year occurrence of myocardial infarction and ischemic heart disease defined as a composite of death from ischemic heart disease, myocardial infarction, and coronary revascularization. Results For individuals with remnant cholesterol levels ≥95th percentile (≥1.6 mmol/L, 61 mg/dL), 23% (P < 0.001) of myocardial infarction and 21% (P < 0.001) of ischemic heart disease were reclassified correctly from below to above 5% for 10-year occurrence when remnant cholesterol levels were added to models based on conventional risk factors, whereas no events were reclassified incorrectly. Consequently, the addition of remnant cholesterol levels yielded NRI of 10% (95% CI: 1%-20%) for myocardial infarction and 5% (95% CI: -3% to 13%) for ischemic heart disease. Correspondingly, when reclassifications were combined from below to above 5%, 7.5%, and 10% risk of events, 42% (P < 0.001) of individuals with myocardial infarction and 41% (P < 0.001) with ischemic heart disease were reclassified appropriately, leading to NRI of respectively 20% (95% CI: 9%-31%) and 11% (95% CI: 2%-21%). Conclusions Elevated remnant cholesterol levels considerably improve myocardial infarction and ischemic heart disease risk prediction.
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High levels of RC are closely related to cardiovascular diseases such as ischemic heart disease, peripheral arterial disease, and hypertension.
“Studies have shown that high levels of RC are closely related to CVDs such as ischemic heart disease (IHD) (10, 11), peripheral arterial disease (PAD) (12, 13), and hypertension (14, 15).”
From Remnant cholesterol, lipid ratios, and the severity of coronary artery lesions: a retrospective cohort study in patients with coronary heart disease (2025) · cites this paper as [10]
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Remnant cholesterol and long-term incidence of death in coronary artery disease patients
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- Authors
- Doi, T., Langsted, A., & Nordestgaard, B. G.
- Affiliations
- University of Copenhagen (DK)
- Corresponding author
- Nordestgaard, Børge G.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2022-06
- Volume
- 79
- Issue
- 24
- Pages
- 2383-2397
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W4282545866
- Cited by
- 129
- References
- 8
- Citations by year
- 2026: 29 · 2025: 28 · 2024: 38 · 2023: 28 · 2022: 5
- FWCI
- 23.10
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by-nc-nd)
- Funders
- Gentofte Hospital
- Novo Nordisk
- Novo Nordisk Fonden (NNF21OC0071977)
- 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, ischemic heart disease, myocardial infarction, cardiovascular risk reclassification, net reclassification improvement, risk prediction, coronary revascularization, coronary heart disease mortality, Copenhagen General Population Study
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