Discordance between remnant cholesterol and low-density lipoprotein cholesterol predicts cardiovascular disease: the Kailuan prospective cohort study.

Objective: Previous studies have shown that remnant cholesterol (RC) is associated with cardiovascular disease (CVD). The study aimed to identify the association of RC and the discordance between RC and lipoprotein cholesterol (LDL-C) with CVD.

Methods: Data were obtained from the Kailuan study. RC was calculated as the non-high-density lipoprotein cholesterol minus LDL-C. Discordant RC and LDL-C were defined by percentile difference and clinical cut-off points. Cox proportional hazard models were used to explore the association of RC and the discordance between RC and LDL-C with CVD.

Results: A total of 96,769 participants were included, with a median age of 51.61 years and 79.56% were male. There was a significant association between RC levels and the risk of CVD, with an HR of 1.10 (95% CI, 1.08-1.13) in the continuous analysis. The group with a discordantly high RC had a significant increase in CVD, MI, and stroke risk, with HRs of 1.18 (95% CI, 1.10-1.26), 1.23 (1.06-1.43), and 1.15 (1.07-1.24), respectively. Compared with the group with low LDL-C and low RC, the group with low LDL-C and high RC had significantly higher incidences of CVD (HR, 1.33 [95% CI, 1.26-1.40]), MI (HR, 1.59 [95% CI, 1.41-1.80]), and stroke (HR, 1.28 [95% CI, 1.20-1.35]).

Conclusions: Elevated levels of RC and discordantly high RC with LDL-C were associated with the risk of CVD, MI, and stroke. These findings demonstrate the clinical significance of identifying residual risk related to RC.