Original ArticlePremature myocardial infarction is strongly associated with increased levels of remnant cholesterol
Introduction
Remnant cholesterol has been defined as the cholesterol present in triglyceride-rich remnant lipoproteins. Previous studies have shown that increased remnant cholesterol is associated with increased cardiovascular risk.1, 2, 3 Studies examining genetic variations in the apolipoprotein A5 gene have suggested a causal association between elevated levels of remnant cholesterol and the development of myocardial infarction.4 Remnant cholesterol consists of very low–density lipoproteins (VLDL) and intermediate-density lipoproteins (IDL) in the fasting state and of VLDL, IDL, and cholesterol present in chylomicrons in the non-fasting state.5 Direct measurement of remnant cholesterol has its pitfalls; however, it can be easily estimated as total cholesterol minus high-density cholesterol (HDL) minus low-density cholesterol (LDL).5
Acute myocardial infarction (AMI) in very young individuals (≤40 years) represents a rare disease with a typical risk factor profile that includes higher smoking rates, more family histories of coronary heart disease, and a lipid phenotype that is characterized by a predominance of elevated triglyceride-rich lipoproteins.6 Therefore, we aimed to investigate the role of remnant cholesterol in very young survivors of myocardial infarction and evaluate its relative importance compared with other lipoprotein fractions.
Section snippets
Study population
Between September 2004 and March 2008, we prospectively included young myocardial infarction patients (≤40 years) referred to the Vienna General Hospital and the Wilhelminen Hospital Vienna, both tertiary care centers, into our multicenter case–control study as previously described.6, 7 Myocardial infarction was diagnosed according to the guidelines of the European Society of Cardiology.8 Two control subjects, free from AMI, were recruited and frequency matched on gender and age within 5-year
Baseline characteristics
We prospectively enrolled 302 patients (102 infarction and 200 age- and gender-matched controls) into our multicenter study. The mean age of patients was 37 years (age range: 34–39), 87% of them were male. Detailed baseline characteristics are summarized in Table 1. Baseline characteristics between control patients according to department of study enrollment were comparable and are displayed in Supplemental Table 1.
Association of remnant cholesterol with clinical risk factors and lipid markers
Remnant cholesterol was significantly elevated in diabetics (58.3 ± 43.6 vs
Discussion
In this case-control study, we were able to demonstrate that of a large variety of lipid parameters, remnant cholesterol had the strongest association with premature myocardial infarction (≤40 years) as compared with age- and gender-matched controls. This association was independent of age, BMI, hypertension, and diabetes. Interestingly, this association was independent of triglycerides, LDL cholesterol, and HDL cholesterol to the multivariate model.
AMI in very young individuals had been
Limitations
Our study has some potential limitations that have to be considered. One possible limitation is the case–control study design, where measurements are obtained after the outcome of interest has already occurred. This fact could bias the results of the analysis if the studied risk factors are influenced by the outcome. Nevertheless, as the prevalence of premature myocardial infarction is low, the case–control study is the epidemiologic study design of choice. Furthermore, there is currently no
Conclusion
In conclusion, we found that remnant cholesterol is the lipid parameter most strongly associated with premature CAD. In addition, this association was independent from triglycerides, LDL, and HDL cholesterol. As remnant cholesterol can be easily calculated with a high accuracy, it might serve as a powerful new risk predictor in this young patient population (≤40 years).
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2023, Clinical Epidemiology and Global HealthCitation Excerpt :Other lipoprotein abnormalities have also been found in patients with cardiovascular diseases including low HDL-C, elevated LDL, and elevated TGY, the LDL/HDL-C ratio and the TGY/HDL-C ratio.24,25 However, few studies showed that these lipid parameters are not associated with symptomatic CVD in cohort regression models.23,26 Yet, multiple studies have shown an association between the sdLDL and AIP with CVD in symptomatic and asymptomatic individuals.15,27
Age dependent association between remnant cholesterol and cardiovascular disease
2021, Atherosclerosis PlusCitation Excerpt :Copenhagen City Heart Study found that the associations between TGs and MI, ischemic heart disease, and death were more pronounced in individuals with age < 55 years vs older than 55 years [3]. Another multicenter case-control study conducted in Vienna focused on young individuals (≤40 years), the results showed that remnant cholesterol was strongly with premature MI [31]. In line with the findings, our analysis found that the risk of CVD was higher in young adults than later adults in the same remnant cholesterol categories, our finding extends these previous reports by quantifying a more contributable role of remnant cholesterol in the development of CVD in young adults, which makes the present findings novel.