Nonfasting remnant cholesterol and cardiovascular disease risk prediction in Albertans: a prospective cohort study

Olivia R. Weaver; Jacqueline A. Krysa; Ming Ye; Jennifer E. Vena; Dean T. Eurich; Spencer D. Proctor

doi:10.9778/cmajo.20210318

Article Figures & Tables

Figures

Tables

Download figure
Open in new tab
Download powerpoint
Figure 1:
Flow diagram of Alberta’s Tomorrow Project (ATP) participant selection. Note: HDL-C = high-density lipoprotein cholesterol, LDL-C = low-density lipoprotein cholesterol, RC = remnant cholesterol, TC = total cholesterol, TG = triglycerides.
Download figure
Open in new tab
Download powerpoint
Figure 2:
Percentage of incident composite cardiovascular disease (CVD) diagnoses and statin users by quartile of nonfasting remnant cholesterol (RC) (A) and low-density lipoprotein cholesterol (LDL-C) (B). Green bars = cardiovascular disease; blue dots = statin users. Categorical lipid variables were used in the regressions; however, the figure shows quartiles plotted at the mean lipid value for each quartile. Note: Q = quartile. Figure created using GraphPad Prism version 9.3.1.
Download figure
Open in new tab
Download powerpoint
Figure 3:
Odds ratios and 95% confidence intervals (CIs) for cardiovascular disease (CVD) incidence per mmol/L increase of nonfasting remnant cholesterol (A) and low-density lipoprotein cholesterol (B) on a logarithmic scale. Adjusted model for (A) and (B) included sex, age, Elixhauser Comorbidity Index, statin use, remnant cholesterol and low-density lipoprotein cholesterol. ^*Aggregate of myocardial infarction and angina. †Aggregate of acute ischemic stroke and transient ischemic attack.

Tables

Figures

View popup

Table 1:

Baseline cohort characteristics and nonfasting lipid panel

Variable	Mean ± SD or no. (%)			Standardized difference
Variable	Total n = 13 988	Without incident CVD n = 12 832	With incident CVD n = 1156	Standardized difference
Age, yr	61.8 ± 9.7	61.2 ± 9.6	68.1 ± 8.6	−0.76
Sex, female	9710 (69.4)	9040 (70.5)	670 (58.0)	0.26
Statin use	2639 (18.9)	2342 (18.3)	297 (25.7)	0.18
Elixhauser Comorbidity Index score	2.80 ± 2.19	2.83 ± 2.19	2.52 ± 2.17	0.14
LDL cholesterol, mmol/L	2.86 ± 0.85	2.88 ± 0.84	2.69 ± 0.93	0.21
HDL cholesterol, mmol/L	1.51 ± 0.44	1.52 ± 0.45	1.39 ± 0.42	0.29
Total cholesterol, mmol/L	5.15 ± 0.96	5.17 ± 0.95	4.95 ± 1.06	0.22
Non-HDL cholesterol, mmol/L	3.65 ± 0.95	3.66 ± 0.94	3.56 ± 1.01	0.10
Remnant cholesterol, mmol/L	0.78 ± 0.38	0.78 ± 0.38	0.87 ± 0.40	−0.24
Triglycerides, mmol/L	1.73 ± 0.84	1.71 ± 0.84	1.92 ± 0.88	−0.25

Note: CVD = cardiovascular disease, HDL = high-density lipoprotein, LDL = low-density lipoprotein, SD = standard deviation.

View popup

Table 2:

Unadjusted and adjusted odds ratios of cardiovascular disease incidence per mmol/L increase of nonfasting remnant cholesterol and low-density lipoprotein cholesterol

Variable	No. (%) n = 13 988	Unadjusted OR (95% CI)	Adjusted^* OR (95% CI)
Remnant cholesterol
CVD composite	1156 (8.3)	1.81 (1.56–2.09)	1.48 (1.27–1.73)
Ischemic heart disease	1056 (7.6)	1.83 (1.57–2.13)	1.49 (1.27–1.75)
Acute coronary syndrome^†	153 (1.1)	2.18 (1.51–3.15)	1.42 (0.97–2.08)
Heart failure	168 (1.2)	1.95 (1.36–2.79)	1.47 (1.01–2.14)
Stroke^‡	53 (0.4)	1.75 (0.92–3.33)	1.12 (0.58–2.17)
LDL cholesterol
CVD composite	1156 (8.3)	0.76 (0.71–0.82)	0.73 (0.68–0.79)
Ischemic heart disease	1056 (7.6)	0.77 (0.71–0.83)	0.74 (0.69–0.81)
Acute coronary syndrome^†	153 (1.1)	0.51 (0.41–0.62)	0.55 (0.44–0.68)
Heart failure	168 (1.2)	0.64 (0.53–0.77)	0.64 (0.53–0.78)
Stroke^‡	53 (0.4)	0.46 (0.33–0.65)	0.47 (0.33–0.69)

Note: CI = confidence interval, CVD = cardiovascular disease, LDL = low-density lipoprotein, OR = odds ratio.
↵* Adjusted model included age, sex, statin use, Elixhauser Comorbidity Index, remnant cholesterol and LDL cholesterol.
↵† Aggregate of myocardial infarction and angina.
↵‡ Aggregate of transient ischemic attack and acute ischemic stroke.

View popup

Table 3:

Unadjusted and adjusted odds ratios of composite cardiovascular disease incidence by quartile of nonfasting remnant cholesterol and low-density lipoprotein cholesterol

Quartile (range)	Unadjusted OR (95% CI)	Adjusted^* OR (95% CI)
Remnant cholesterol
1 (0.06–0.49)	1.00 (Ref.)	1.00 (Ref.)
2 (0.50–0.70)	1.13 (0.93–1.36)	0.97 (0.80–1.19)
3 (0.71–0.99)	1.62 (1.35–1.94)	1.38 (1.15–1.67)
4 (1.00–2.04)	1.86 (1.56–2.22)	1.46 (1.22–1.76)
LDL cholesterol
1 (0.26–2.28)	1.00 (Ref.)	1.00 (Ref.)
2 (2.29–2.82)	0.65 (0.55–0.77)	0.63 (0.53–0.75)
3 (2.83–3.40)	0.57 (0.49–0.68)	0.52 (0.44–0.63)
4 (3.41–8.83)	0.62 (0.52–0.73)	0.52 (0.43–0.62)

Note: CI = confidence interval, LDL = low-density lipoprotein, OR = odds ratio, Ref. = reference category.
↵* Adjusted model included age, sex, statin use, Elixhauser Comorbidity Index, remnant cholesterol and LDL cholesterol.