Testing ‘remnant cholesterol’ for risk of heart attack and stroke

Sept. 9, 2021

In a study using data from 17,000 adults, researchers from Johns Hopkins Medicine found that “remnant cholesterol” (RC) can be an accurate predictor of risk for clogged arteries, heart attacks and stroke.

RC measures how much cholesterol is in remnant lipoproteins, a form of very low-density lipoproteins (VLDL) that have triglycerides removed. Though LDL, or “bad cholesterol,” measurements are the traditional quantifications tested for in labs, the remaining cholesterol within remnant lipoproteins has been studied as an another means of screening a person’s risk for developing cardiovascular disease and stroke. Remnant cholesterol levels are the total cholesterol amount minus the LDL and high-density lipoprotein cholesterol, known as HDL or the “good cholesterol.”

Researchers discovered people with relatively low levels of LDL cholesterol, a measured RC level greater than 24 micrograms per deciliter (24 millionths of a gram in a little more than a quart) of blood have a 40–50% higher risk for major heart disease or stroke. Commonly, people thought low LDL and high HDL were low risk for heart disease, but studies show RC predicted heart disease independent of LDL levels.

The Johns Hopkins Medicine team assessed information from 17,532 adults, between the ages of 30 and 68, with no history of atherosclerotic cardiovascular disease (buildup of fatty plaque inside arteries). Data included cholesterol levels and other important cardiovascular risk factors, as well as which people developed major heart disease or stroke after recruitment to one of the databases.

Researchers found nearly one of five people with levels of RC at or greater than 24 micrograms per deciliter experienced major heart disease or stroke within the following 18 years. Interestingly, this proportion was similar to those who had relatively low LDL cholesterol.

They found people with higher levels of RC had more obesity and diabetes, and almost everyone had high triglyceride levels.  Calculating remnant cholesterol can be done easily with data available from a standard lipid panel, a common test given to patients by their doctors.

The U.S. Centers for Disease Control and Prevention estimates that 38 percent of the American adult population has high levels of total cholesterol, and one in four shows high levels of triglycerides. One-third of all deaths in this country are attributed to heart disease, stroke and other cardiovascular disease.

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