Remnant Cholesterol and Myocardial Infarction in Normal Weight, Overweight, and Obese Individuals from the Copenhagen General Population Study

TY - JOUR

T1 - Remnant Cholesterol and Myocardial Infarction in Normal Weight, Overweight, and Obese Individuals from the Copenhagen General Population Study

AU - Varbo, Anette

AU - Freiberg, Jacob J

AU - Nordestgaard, Børge G

N1 - © 2017 American Association for Clinical Chemistry.

PY - 2018/1

Y1 - 2018/1

N2 - BACKGROUND: We tested whether high remnant cholesterol is associated with high myocardial infarction risk, independent of whether an individual is normal weight, overweight, or obese. METHODS: A total of 106216 individuals from the Copenhagen General Population Study were followed for up to 11 years, during which 1565 experienced a myocardial infarction. Individuals were grouped by clinically meaningful remnant cholesterol concentrations of < 0.5 mmol/L (19 mg/dL), 0.5 to 0.99 mmol/L (19-38 mg/dL), 1.0 to 1.49 mmol/L (39-58 mg/dL), and ≥1.5 mmol/L(58 mg/dL), and by body mass index (BMI) of≥18.5 kg/m2 (underweight), 18.5 to 24.9 kg/m2 (normal weight), 25 to 29.9 kg/m2 (overweight), and 30 kg/m2 (obese). RESULTS: Median calculated remnant cholesterol was 0.40 mmol/L [interquartile range (IQR), 0.30-0.55 mmol/L] [15 mg/dL (12-21 mg/dL)] for underweight, 0.50 mmol/L (IQR, 0.37- 0.71 mmol/L) [19 mg/dL (14-27 mg/dL)] for normal weight, 0.70 mmol/L (IQR, 0.49 -1.00 mmol/L) [27 mg/dL (19-39 mg/dL)] for overweight, and 0.85 mmol/L (IQR, 0.61-1.20 mmol/L) [(33 mg/dL (24-46 mg/dL)] for obese individuals. On continuous scales, remnant cholesterol was positively correlated with BMI until reaching a plateau of approximately 1 mmol/L (39 mg/dL) at BMI >35 kg/m2. R2 from an unadjusted linear regression for the correlation between calculated remnant cholesterol and BMI was 12%. Stepwise higher remnant cholesterol was associated with stepwise higher myocardial infarction risk in a similar pattern for normal weight, overweight, and obese individuals. When compared with individuals with remnant cholesterol 0.5 mmol/L (19 mg/dL), individuals with remnant cholesterol >1.5 mmol/L (58 mg/dL) had hazard ratios for myocardial infarction of 2.0 (95% CI, 1.3-3.2) for normal weight, 1.9 (95% CI, 1.4 -2.6) for overweight, and 2.3 (95% CI, 1.4 -3.5) for obese individuals. Directly measured remnant cholesterol increased 0.91 mmol/L (95% CI, 0.89-0.94 mmol/L) [35 mg/dL (34-36 mg/dL)] per 1 mmol/L (39 mg/dL) increase in calculated remnant cholesterol. CONCLUSIONS: Remnant cholesterol and BMI were positively correlated; however, high remnant cholesterol was associated with higher myocardial infarction risk across the examined BMI subcategories, indicating that remnant cholesterol is a risk factor for myocardial infarction independent of overweight and obesity.

AB - BACKGROUND: We tested whether high remnant cholesterol is associated with high myocardial infarction risk, independent of whether an individual is normal weight, overweight, or obese. METHODS: A total of 106216 individuals from the Copenhagen General Population Study were followed for up to 11 years, during which 1565 experienced a myocardial infarction. Individuals were grouped by clinically meaningful remnant cholesterol concentrations of < 0.5 mmol/L (19 mg/dL), 0.5 to 0.99 mmol/L (19-38 mg/dL), 1.0 to 1.49 mmol/L (39-58 mg/dL), and ≥1.5 mmol/L(58 mg/dL), and by body mass index (BMI) of≥18.5 kg/m2 (underweight), 18.5 to 24.9 kg/m2 (normal weight), 25 to 29.9 kg/m2 (overweight), and 30 kg/m2 (obese). RESULTS: Median calculated remnant cholesterol was 0.40 mmol/L [interquartile range (IQR), 0.30-0.55 mmol/L] [15 mg/dL (12-21 mg/dL)] for underweight, 0.50 mmol/L (IQR, 0.37- 0.71 mmol/L) [19 mg/dL (14-27 mg/dL)] for normal weight, 0.70 mmol/L (IQR, 0.49 -1.00 mmol/L) [27 mg/dL (19-39 mg/dL)] for overweight, and 0.85 mmol/L (IQR, 0.61-1.20 mmol/L) [(33 mg/dL (24-46 mg/dL)] for obese individuals. On continuous scales, remnant cholesterol was positively correlated with BMI until reaching a plateau of approximately 1 mmol/L (39 mg/dL) at BMI >35 kg/m2. R2 from an unadjusted linear regression for the correlation between calculated remnant cholesterol and BMI was 12%. Stepwise higher remnant cholesterol was associated with stepwise higher myocardial infarction risk in a similar pattern for normal weight, overweight, and obese individuals. When compared with individuals with remnant cholesterol 0.5 mmol/L (19 mg/dL), individuals with remnant cholesterol >1.5 mmol/L (58 mg/dL) had hazard ratios for myocardial infarction of 2.0 (95% CI, 1.3-3.2) for normal weight, 1.9 (95% CI, 1.4 -2.6) for overweight, and 2.3 (95% CI, 1.4 -3.5) for obese individuals. Directly measured remnant cholesterol increased 0.91 mmol/L (95% CI, 0.89-0.94 mmol/L) [35 mg/dL (34-36 mg/dL)] per 1 mmol/L (39 mg/dL) increase in calculated remnant cholesterol. CONCLUSIONS: Remnant cholesterol and BMI were positively correlated; however, high remnant cholesterol was associated with higher myocardial infarction risk across the examined BMI subcategories, indicating that remnant cholesterol is a risk factor for myocardial infarction independent of overweight and obesity.

KW - Journal Article

U2 - 10.1373/clinchem.2017.279463

DO - 10.1373/clinchem.2017.279463

M3 - Journal article

C2 - 29021326

SN - 0009-9147

VL - 64

SP - 219

EP - 230

JO - Clinical Chemistry

JF - Clinical Chemistry

IS - 1

ER -