Physicians' Academy for Cardiovascular Education

Elevated remnant cholesterol improves MI and IHD risk prediction

Elevated remnant cholesterol reclassifies risk of ischemic heart disease and myocardial infarction

Literature - Doi T, Langsted A, Nordestgaard BG. - J Am Coll Cardiol. 2022 Jun 21;79(24):2383-2397. doi: 10.1016/j.jacc.2022.03.384.

Introduction and methods


Remnant cholesterol consists of the cholesterol content of triglyceride-rich VLDL, IDL and chylomicron remnants. Observational studies and Mendelian randomization studies have demonstrated robust associations of elevated remnant cholesterol levels with an increased risk of ischemic heart disease (IHD), including myocardial infarction (MI) [1-7]. In most guidelines, total cholesterol and HDL-c levels are included for predicting the 10-year risk of ischemic and atherosclerotic heart disease, but remnant cholesterol levels are not.

Aim of the study

The aim of this study was to determine whether adding remnant cholesterol to a risk model with conventional risk factors leads to better identification of individuals who later experience MI or IHD.


The researchers used data from 41,928 white Danish individuals who were enrolled in the Copenhagen General Population Study. The median follow-up time was 12 years (IQR: 10.7-13.5). At baseline, participants did not have IHD or diabetes and were not taking a statin. Nonfasting remnant cholesterol levels were calculated by subtracting LDL-c and HDL-c levels from total cholesterol levels. The researchers used a risk model with and without remnant cholesterol levels as a risk factor to predict the 10-year risk of MI and IHD. Conventional risk factors were age, sex, smoking, LDL-c levels and systolic blood pressure. Participants were divided into predefined 10-year risk categories:<5% and ≥5%, <7.5% and ≥7.5%, and <10% and ≥10%.


Based on predefined cut points for elevated remnant cholesterol levels, the researchers calculated the net reclassification improvement (NRI) for MI and IHD for each of the 10-year risk categories. IHD was defined as death from IHD, MI or coronary revascularization.

Main results


The results of this large-scale Danish population study suggest that adding remnant cholesterol to a risk model with conventional risk factors leads to a considerable improvement in MI and IHD risk prediction in individuals with elevated remnant cholesterol.


Show references

Find this article online at J Am Coll Cardiol.

Share this page with your colleagues and friends: