Remnant cholesterol and not LDL cholesterol prognostic indicator of CVD: JACC study
Spain: Not Low Density Lipoprotein cholesterol or High Density Lipoprotein cholesterol but remnant cholesterol (remnant-C) and triglycerides levels were associated with CVD outcomes in obese or overweight people, suggests a recent study in the Journal of the American College of Cardiology. The findings indicated that remnant-C defined as cholesterol transported in triglyceride-rich lipoproteins, should be considered as preferential treatment target in this group of patients.
Remnant cholesterol is comprised primarily of very low-density lipoprotein (VLDL) and intermediate-density lipoprotein (IDL).
Observational, genetic and clinical intervention studies have suggested that circulating levels of triglycerides and remnant cholesterol can predict cardiovascular events. The study by Olga Castañer, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain, and colleagues evaluated the association of triglycerides and remnant-C with major cardiovascular (CV) events in a cohort of older individuals at high cardiovascular risk.
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).
The PREDIMED study was a randomized controlled trial conducted in Spain that examined the effects of the Mediterranean diet (MedDiet) compared with a low-fat diet for the primary prevention of CVD in high-risk subjects. PREDIMED trial participants had a high prevalence of diabetes, obesity, and metabolic syndrome, conditions that are associated with insulin resistance, hypertriglyceridemia, and atherogenic dyslipidemia (17). Thus, this cohort of subjects at high cardiovascular risk was well suited to investigate the association of triglycerides and TRLs with cardiovascular outcomes.
Key findings of the study include:
- In multivariable-adjusted analyses, triglycerides, non−high-density lipoprotein cholesterol (HDL-C), and remnant-C, 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).
"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," concluded the authors.
"Remnant Cholesterol, Not LDL Cholesterol, Is Associated With Incident Cardiovascular Disease," is published in the Journal of the American College of Cardiology.
DOI: https://www.jacc.org/doi/10.1016/j.jacc.2020.10.008
