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

This is the title of the study just published in JACC vol 76(No.23) :2712-24) authored by Dr.Olga Castner et al.There are several ,very important comments made in this manuscript that I fully endorse. I have recommended treatment of elevated remnant lipoprotein cholesterol(remnant-C) in high risk patients for many years.

Study Design: "The PREDIMED study was a multi-center,randomized clinical trial that tested the efficacy of MedDiets enriched with extra-virgin olive oil or mixed nuts against a control diet diet for the primary prevention of CVD in older patients at high CV risk'

Remnant lipoprotein cholesterol (Remnant-C) was simply measured as Total cholesterol minus LDL-c minus HDL-c.(As us lipidologists know this converts to Triglycerides/5)

In multivariable -adjusted analysis,triglycerides(HR):1.04;95%CI:1.02 to 1.06,per 10mg/dl(0.11mmol/l);p<0.001,non-HDL-C(HR):1.05;95% CI:1.01 to 1.10,per 10mg/dl(0.26mmol/l);p=0.026) and remnant-C(HR:1.21;95% CI: 1.10 to 1.33 per 10mg/dl(0.26mmol/l);p<0.001), but not LDL-C or HDL-C were associated with MACEs.

"Remnant-c was the major cholesterol fraction contributor to MACEs in our cohort of participants at high cardiovascular risk but who had no previous CVD;these subjects had moderately elevated triglyceride concentrations and a high frequency of statin treatment"

"Participants with Remnant-c levels >/= 30mg/dl (75th percentile of the cohort)had a higher risk of MACEs,regardless of whether LDL-c was at optimal levels(</=100mg/dl;2.59mmole/l)."

"From the present data,it could be inferred that treatment of residual risk,measured as triglycerides or remnant-C,was probably more beneficial than further reducing LDL-c in high-risk subjects in primary prevention not eligible for statin treatment or already treated with moderate- or high dose statins"

Take a look at Figure 4 and the LDL-c and remnant-C Kaplan-Meier curves.....Amazing!!!

Mt Hat is off to Dr.Olga Castaner and colleagues for a such a wonderful and extremely clinically relevant paper

I would like to add that the FDA approved ,prescription icosapent ethyl plays a key role in reducing CV events in patients with Triglycerides >/=150mg/dl with CVD or DM and 2 or more additional risk factors for CVD.

For those who want to read more about "The Role of Remnant Lipoproteins in Atherogenesis" I refer you to the paper authored by myself and Paul N. Hopkins,MD,MSPH published in the National Lipid Associations Lipid Spin Volume 11(2) Spring Issue 2013,pages12-15,38-39.