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Remnant cholesterol associated with coronary atheroma progression

In statin-treated patients with pre-existing coronary artery disease (CAD), higher remnant cholesterol levels were associated with greater coronary atheroma progression and higher 2-year rates for major adverse cardiovascular events (MACE), according to the results of this study. This report describes a post hoc analysis of 5,754 CAD patients (mean age 58.1 years, 28% women) from 10 trials who underwent serial intravascular ultrasonography. Almost all (96%) were treated with a statin. Remnant cholesterol was calculated as: non-high-density lipoprotein cholesterol – low-density lipoprotein cholesterol (estimated using the Hopkins–Martin equation)). The key variables were 1) the change in percentage atheroma volume (PAV) and 2) 2-year MACE event rates. On-treatment remnant cholesterol levels were significantly correlated with PAV progression (p<0.001), even after adjustment for clinical trial duration, baseline PAV, on-treatment low-density lipoprotein cholesterol, apolipoprotein B, high-density lipoprotein cholesterol, C-reactive protein and other clinical risk factors. 2-year MACE rates increased progressively with increasing remnant cholesterol levels, from 14% in patients with remnant cholesterol <17.8 mg/dL to 23% in patients with remnant cholesterol >32.7 mg/dL, p<0.001. The authors conclude that the findings from this analysis support further investigation of therapeutic strategies targeting remnant cholesterol in statin-treated patients with persistent residual atherosclerotic cardiovascular disease risk.
Remnant cholesterol, coronary atheroma progression and clinical events in statin-treated patients with coronary artery disease.

Elshazly MB, Mani P, Nissen S et al.