The relevance of remnant cholesterol as a guide for lipid management in Indian subjects undergoing coronary revascularization

• Published in: Diabetes & metabolic syndrome clinical research & reviews Vol. 19; no. 1; p. 103183
• Main Authors: Bansal, Manish, Kasliwal, Ravi R., Chandra, Praveen, Kapoor, Rajneesh, Chouhan, Nagendra, Bhan, Anil, Trehan, Naresh
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.01.2025
• Subjects: Aged; Apolipoprotein B; Biomarkers - blood; Cholesterol - blood; Cholesterol, LDL - blood; Coronary Artery Disease - blood; Coronary Artery Disease - surgery; Female; Follow-Up Studies; Humans; India - epidemiology; Lipid-lowering therapy; Lipoproteins - blood; Male; Middle Aged; Myocardial Revascularization; Non-HDL cholesterol; Prognosis; Retrospective Studies; Triglyceride-rich lipoproteins; Triglycerides - blood; India; Apolipoprotein B; Triglyceride-rich lipoproteins; Non-HDL cholesterol; Lipid-lowering therapy
• ISSN: 1871-4021; 1878-0334; 1878-0334
• DOI: 10.1016/j.dsx.2024.103183

The atherogenic potential of remnant cholesterol, which refers to the cholesterol content of triglyceride-rich, non-low-density lipoprotein (LDL) particles in circulation, has gained increasing attention recently. Unfortunately, very limited information is available regarding remnant cholesterol levels in Indian subjects. This was a retrospective study conducted at a premier, tertiary care center in North India. A total of 3064 consecutive subjects [mean age 61.3 ± 10.3 years, 2550 (83.2%) men] with newly diagnosed coronary artery disease (CAD) undergoing coronary revascularization were included. Enzymatic assays were used for measuring various lipid parameters. Remnant cholesterol was calculated by subtracting LDL cholesterol (LDL-C) and high-density lipoprotein cholesterol from total cholesterol. A value >30 mg/dL was considered elevated. The mean LDL-C was 79.1 ± 33.1 mg/dL with 46.4% of all subjects having LDL-C <70 mg/dL and only 16.9% having LDL-C <50 mg/dL. The median remnant cholesterol level was 17.0 mg/dL (interquartile range 12.0–24.0 mg/dL) with only 11.9% of subjects having values >30 mg/dL. Only 4.5% of the patients with LDL-C <70 mg/dL and 2.9% of those with LDL-C <50 mg/dL had elevated remnant cholesterol. These proportions were significantly greater in patients with serum triglycerides >200 mg/dL. Our study shows that in a North-Indian population with CAD, elevated remnant cholesterol was present in only a small proportion. The prevalence of elevated remnant cholesterol decreased further as the LDL-C control improved. These findings suggest that elevated remnant cholesterol may not be a clinically relevant therapeutic target in most patients with LDL-C below the currently recommended goals. •Remnant cholesterol is highly atherogenic and may be particularly relevant for Indians.•However, in our study, the patients undergoing coronary revascularization had generally low levels of remnant cholesterol.•Very few patients with well controlled low density lipoprotein cholesterol had elevated remnant cholesterol.