Elsevier

Journal of Clinical Lipidology

Volume 9, Issue 6, November–December 2015, Pages 801-806.e1
Journal of Clinical Lipidology

Original Article
Premature myocardial infarction is strongly associated with increased levels of remnant cholesterol

https://doi.org/10.1016/j.jacl.2015.08.009Get rights and content

Highlights

  • Remnant cholesterol is strongly associated with premature myocardial infarction.

  • Remnant cholesterol can be easily calculated with a high accuracy.

  • Remnant cholesterol might serve as a powerful risk predictor in these young patients.

Background

Remnant cholesterol has been defined as the cholesterol present in triglyceride-rich remnant lipoproteins. Elevated levels of remnant cholesterol have been associated with increased cardiovascular risk. Acute myocardial infarction (AMI) in very young individuals (≤40 years) represents a rare disease with a typical risk factor profile and a lipid phenotype that is characterized by a predominance of elevated triglyceride-rich lipoproteins.

Objective

The aim of this study was to investigate the role of remnant cholesterol in premature AMI.

Methods

We prospectively enrolled 302 patients into our multicenter case-control study comprising 102 consecutive myocardial infarction survivors (≤40 years) and 200 hospital controls. Myocardial infarction patients were frequency matched for age, gender, and center. Remnant cholesterol was calculated from standard lipid parameters.

Results

Remnant cholesterol was 1.7-fold higher in premature AMI patients compared with controls (61.1 ± 36.8 vs 35.8 ± 16.8 mg/dL; P < .001). Remnant cholesterol was the lipid fraction most strongly associated with premature myocardial infarction (odds ratio 3.87; 95% confidence interval 2.26–6.64; P < .001) for an increase of 1-standard deviation. This observation was independent from clinical risk factors and plasma lipid levels.

Conclusions

Remnant cholesterol is strongly associated with premature myocardial infarction, can be easily calculated, and might serve as a new potent risk marker in this young patient population.

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).

References (20)

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