Remnant Cholesterol Predicts Cardiovascular Events Among Patients With Coronary Artery Disease

ACS, STEMI, acute coronary syndrome
ACS, STEMI, acute coronary syndrome
Austrian researchers investigated the utility of remnant cholesterol as a marker of cardiovascular event risk in coronary artery disease.

The following article is a part of conference coverage from the American College of Cardiology’s 70th Annual Scientific Session & Expo is being held virtually from May 15 to 17, 2021. The team at Cardiology Advisor will be reporting on the latest news and research conducted by clinicians and scientists in the field. Check back for more from the ACC 2021 .

Remnant cholesterol predicted cardiovascular events among patients with coronary artery disease (CAD), irrespective of diabetes status. These findings were presented during the American College of Cardiology annual meeting, held virtually May 15-17, 2021.

Remnant cholesterol is calculated by the total cholesterol minus low-density and high-density lipoprotein cholesterols. This value has been established as a marker for cardiovascular events among some patients. The utility of using this marker among patients with CAD has not been verified.

To assess the utility of remnant cholesterol among a CAD patient population, researchers at the Vorarlberg Institute for Vascular Investigation and Treatment in Austria enrolled patients (N=1350) with angiographically confirmed CAD. Cardiovascular events during a mean follow-up period of 10.4±4.8 years were associated with remnant cholesterol and comorbidities.

At baseline, patients with type 2 diabetes (n=428) had higher remnant cholesterol (mean, 29±24 mg/dL) compared with patients without diabetes (mean, 24±22 mg/dL; P <.001).

A total of 651 cardiovascular events occurred during follow-up. Among the patients who had a cardiovascular event, patients with type 2 diabetes were over-represented (56.9%) compared with patients who did not have diabetes (44.9%; P <.001).

In a regression analysis, after correcting for age, sex, body mass index, low-density lipoprotein cholesterol, hypertension, and smoking status, the investigators found that remnant cholesterol was predictive of cardiovascular events among patients with type 2 diabetes (adjusted hazard ratio [aHR], 1.19; 95% CI, 1.05-1.35; P =.006), without diabetes (aHR, 1.12; 95% CI, 1.02-1.23; P =.010), and among all patients (aHR, 1.15; 95% CI, 1.07-1.23; P <.001).

This study may have been limited by not including information about patient medications, such as lipid-lowering therapies.

The data from this study indicate that patients with CAD and type 2 diabetes may be more likely to have higher remnant cholesterol and to experience a cardiovascular event. Among all patients, regardless of diabetes status, remnant cholesterol was predictive of cardiovascular event risk.


Saely CH, Maechler M, Mader A, et al. Remnant cholesterol in patients with established coronary artery disease predicts cardiovascular events both among patients with type 2 diabetes and among non-diabetic subjects. Presented at: American College of Cardiology Annual Meeting; May 15-17, 2021. Abstract.

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