Abstract 15227: Extreme Nonfasting Remnant Cholesterol versus Extreme Low-Density Lipoprotein Cholesterol as Contributors of Cardiovascular Disease and All-Cause Mortality
Introduction: Elevated levels of nonfasting remnant cholesterol like elevated low-density lipoprotein(LDL) cholesterol levels are causally associated with increased risk of ischemic heart disease(IHD). Extreme levels of these two lipoproteins may therefore be equal contributors to risk of IHD, myocardial infarction(MI), and all-cause mortality.
Hypothesis: Elevated nonfasting remnant and LDL cholesterol are associated with increased risk of IHD, MI, and all-cause mortality in the general population.
Methods: We compared stepwise increasing levels of nonfasting remnant and LDL cholesterol for association with risk of IHD, MI, and all-cause mortality in 88,903 individuals from the Danish general population; 4,743 participants developed IHD, 1,833 developed MI, and 8,706 died during up to 22 years without losses to follow-up.
Results: Compared to participants with nonfasting remnant cholesterol levels <0.5mmol/L, multivariable adjusted hazard ratios for IHD ranged from 1.4(95%CI:1.2-1.6) for remnant cholesterol of 0.5-0.99mmol/L to 2.5(2.1-3.1) for remnant cholesterol >1.5mmol/L(P-trend<0.001). Compared to participants with LDL cholesterol <3.0mmol/L, hazard ratios for IHD ranged from 1.3(1.2-1.5) for LDL cholesterol of 3-3.99mmol/L to 3.0(2.5-3.6) for LDL cholesterol >5mmol/L(P<0.001). Corresponding hazard ratios for MI ranged from 1.9(1.5-2.4) to 3.4(2.4-4.6) for remnant cholesterol(P<0.001), and from 1.8(1.5-2.3) to 6.5(5.0-8.5) for LDL cholesterol(P<0.001), respectively. Nonfasting remnant cholesterol levels were also associated stepwise with all-cause mortality ranging from a hazard ratio of 1.1(1.0-1.2) to 1.6(1.4-1.9)(P<0.001); however, only LDL cholesterol levels >5mmol/L were associated with increased risk of all-cause mortality with a hazard ratio of 1.4(1.2-1.6)(P<0.001).
Conclusion: Both lipoproteins were associated equally with risk of IHD and MI; however, only extremely high levels of LDL cholesterol were associated with all-cause mortality whereas nonfasting remnant cholesterol levels were associated stepwise with all-cause mortality.
Author Disclosures: A. Varbo: None. J.J. Freiberg: None. B.G. Nordestgaard: Consultant/Advisory Board; Modest; AstraZeneca, Merck, Omthera, Sanofi-Aventis/Regeneron, and ISIS Pharmaceuticals.
- © 2014 by American Heart Association, Inc.