Table 1

Major prospective studies of remnant cholesterol and incident cardiovascular disease.

AuthorYear publishedSample sizeStudy settingFasting statusMeasurementOutcomeAdjustedarisk association
HR or OR (95% CI)
Phillips NR et al. (70)1993335Montreal Heart StudyFastingUltracentrifugation: IDL-C+VLDL-CComposite: MI, coronary revascularization, cardiac death1.02b (1.01–1.03) per 1 mg/dL increase
Kugiyama K et al. (71)1999147Patients with Angiographic CADFasting

Immunoseparation

remnant TRL-C

Composite: MI, recurrent, or refractory angina requiring coronary revascularization, cardiac death

6.38b (2.3–17.6)

highest vs lowest tertile

McNamara JR et al. (72)20011567Framingham Heart Study, WomenFasting

Immunoseparation

remnant TRL-C

Composite: angina, MI, TS, TIA

2.27b (1.37–3.77)

highest quartile vs all others

Fukushima H et al. (73)2004120Patients with Angiographic CAD and DiabetesFasting

Immunoseparation

remnant TRL-C

Composite: MI, refractory angina requiring coronary revascularization, cardiac death

2.2b (1.2–6.4)

highest quartile vs all others

Imke C et al. (74)20051156Japanese-American MenFasting

Immunoseparation

remnant TRL-C

Composite: MI, revascularization, sudden death

Normal TG: 1.009 (0.939–1.085)

High TG: 1.011 (1.001–1.021)

per mg/dl

Mora S et al. (75)200927 673Women’s Health StudyNonfastingNMR small, medium, large, and total VLDL particle concentrationComposite: MI, IS, coronary revascularization, CVD death

Small VLDL: 1.56 (1.27–1.91)

Medium VLDL: 1.46 (1.17–1.82)

Large VLDL: 1.77 (1.34–2.33)

Total VLDL: 1.71 (1.38–2.12)

highest vs lowest quintile

Varbo A et al. (76)201373 513Copenhagen General Population Study, Copenhagen City Heart Study, and Copenhagen Ischemic Heart Disease StudyNonfastingCalculated as TC minus HDL-C minus LDL-CIschemic heart disease

2.3 (1.7–3.1)

highest vs lowest quintile

Joshi PH et al. (77)20164114

Jackson Heart Study,

Black Participants

FastingVAP: VLDL3 plus IDL-CComposite: MI, CHD death, revascularization1.18 (1.00–1.39) per SD increase
Joshi PH et al. (77)2016818Framingham Offspring Cohort StudyFastingVAP: VLDL3 plus IDL-CComposite: MI, CHD death, revascularization1.46 (1.05–2.04) per SD increase
Lawler P et al. (78)201711 984Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER)NonfastingNMR small, medium, large, and total VLDL particle concentrationComposite: MI, stroke, hospitalization for unstable angina, arterial revascularization, and CVD death

Small VLDL: 1.16 (0.99–1.36)

Medium VLDL: 1.30 (1.10–1.53)

Large VLDL: 1.17 (1.00–1.37)

Total VLDL: 1.21 (1.04–1.41)

per SD increase

Varbo A et al. (67)2018106 216Copenhagen General Population Study, Stratified by WeightNonfastingCalculated as TC minus HDL-C minus LDL-CMI

Normal Weight: 2.0 (1.3–3.2)

Overweight: 1.9 (1.4–2.6)

Obese: 2.3 (1.4–3.5)

highest vs lowest quartile

Aday A et al. (79)201827 888Women’s Health StudyNonfastingNMR very small, small, medium, large, very large, and total VLDL particle concentrationPAD

Very Small VLDL: 1.01 (0.61–1.67)

Small VLDL: 0.99 (0.62–1.59)

Medium VLDL: 1.98 (1.15–3.41)

Large VLDL: 1.58 (0.94–2.68)

Very Large VLDL: 1.68 (1.05–2.55)

Total VLDL: 1.39 (0.81–2.38)

highest vs lowest tertile

Holmes M et al. (80)2018

4662

(Nested Case-Control)

Chinese Kadoorie Biobank (N = 512 891)NonfastingNMR metabolomics remnant cholesterol (VLDL-C plus IDL-C)MI, IS individually

1.27 (1.15–1.39) for MI

1.20 (1.09–1.32) for IS

per SD increase

Saeed A et al. (69)20189334Atherosclerosis Risk in Communities StudyFasting

Direct homogenous assay for TRL-C,

first generation

CHD, IS, CVD individually

b1.06 (0.88–1.27) for CHD

b1.07 (0.78–1.45) for IS

b1.05 (0.89–1.23) for CVD

highest vs lowest quartile

Vallejo-Vaz et al. (81)20189993Treating to New TargetsFastingCalculated as non-HDL-C minus LDL-CComposite: MI, total stroke, resuscitated cardiac arrest, and CVD death

Atorvastatin 10 mg: 1.48 (1.15–1.92)

Atorvastatin 80 mg: 1.01 (0.76–1.34)

highest vs lowest quintile

Varbo A et al. (82)2019102 964Copenhagen General Population StudyNonfastingCalculated as TC minus HDL-C minus LDL-CIS

1.99 (1.49–2.67)

highest vs lowest quartile

Duran EK et al. (68)2020

976

(Case-Cohort)

Women’s Health Study (N = 27 552)NonfastingDirect homogenous assay for TRL-C, second generationComposite: MI, IS, PAD, and CVD death

1.97 (95% CI: 1.26–3.08)

highest vs lowest quartile

AuthorYear publishedSample sizeStudy settingFasting statusMeasurementOutcomeAdjustedarisk association
HR or OR (95% CI)
Phillips NR et al. (70)1993335Montreal Heart StudyFastingUltracentrifugation: IDL-C+VLDL-CComposite: MI, coronary revascularization, cardiac death1.02b (1.01–1.03) per 1 mg/dL increase
Kugiyama K et al. (71)1999147Patients with Angiographic CADFasting

Immunoseparation

remnant TRL-C

Composite: MI, recurrent, or refractory angina requiring coronary revascularization, cardiac death

6.38b (2.3–17.6)

highest vs lowest tertile

McNamara JR et al. (72)20011567Framingham Heart Study, WomenFasting

Immunoseparation

remnant TRL-C

Composite: angina, MI, TS, TIA

2.27b (1.37–3.77)

highest quartile vs all others

Fukushima H et al. (73)2004120Patients with Angiographic CAD and DiabetesFasting

Immunoseparation

remnant TRL-C

Composite: MI, refractory angina requiring coronary revascularization, cardiac death

2.2b (1.2–6.4)

highest quartile vs all others

Imke C et al. (74)20051156Japanese-American MenFasting

Immunoseparation

remnant TRL-C

Composite: MI, revascularization, sudden death

Normal TG: 1.009 (0.939–1.085)

High TG: 1.011 (1.001–1.021)

per mg/dl

Mora S et al. (75)200927 673Women’s Health StudyNonfastingNMR small, medium, large, and total VLDL particle concentrationComposite: MI, IS, coronary revascularization, CVD death

Small VLDL: 1.56 (1.27–1.91)

Medium VLDL: 1.46 (1.17–1.82)

Large VLDL: 1.77 (1.34–2.33)

Total VLDL: 1.71 (1.38–2.12)

highest vs lowest quintile

Varbo A et al. (76)201373 513Copenhagen General Population Study, Copenhagen City Heart Study, and Copenhagen Ischemic Heart Disease StudyNonfastingCalculated as TC minus HDL-C minus LDL-CIschemic heart disease

2.3 (1.7–3.1)

highest vs lowest quintile

Joshi PH et al. (77)20164114

Jackson Heart Study,

Black Participants

FastingVAP: VLDL3 plus IDL-CComposite: MI, CHD death, revascularization1.18 (1.00–1.39) per SD increase
Joshi PH et al. (77)2016818Framingham Offspring Cohort StudyFastingVAP: VLDL3 plus IDL-CComposite: MI, CHD death, revascularization1.46 (1.05–2.04) per SD increase
Lawler P et al. (78)201711 984Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER)NonfastingNMR small, medium, large, and total VLDL particle concentrationComposite: MI, stroke, hospitalization for unstable angina, arterial revascularization, and CVD death

Small VLDL: 1.16 (0.99–1.36)

Medium VLDL: 1.30 (1.10–1.53)

Large VLDL: 1.17 (1.00–1.37)

Total VLDL: 1.21 (1.04–1.41)

per SD increase

Varbo A et al. (67)2018106 216Copenhagen General Population Study, Stratified by WeightNonfastingCalculated as TC minus HDL-C minus LDL-CMI

Normal Weight: 2.0 (1.3–3.2)

Overweight: 1.9 (1.4–2.6)

Obese: 2.3 (1.4–3.5)

highest vs lowest quartile

Aday A et al. (79)201827 888Women’s Health StudyNonfastingNMR very small, small, medium, large, very large, and total VLDL particle concentrationPAD

Very Small VLDL: 1.01 (0.61–1.67)

Small VLDL: 0.99 (0.62–1.59)

Medium VLDL: 1.98 (1.15–3.41)

Large VLDL: 1.58 (0.94–2.68)

Very Large VLDL: 1.68 (1.05–2.55)

Total VLDL: 1.39 (0.81–2.38)

highest vs lowest tertile

Holmes M et al. (80)2018

4662

(Nested Case-Control)

Chinese Kadoorie Biobank (N = 512 891)NonfastingNMR metabolomics remnant cholesterol (VLDL-C plus IDL-C)MI, IS individually

1.27 (1.15–1.39) for MI

1.20 (1.09–1.32) for IS

per SD increase

Saeed A et al. (69)20189334Atherosclerosis Risk in Communities StudyFasting

Direct homogenous assay for TRL-C,

first generation

CHD, IS, CVD individually

b1.06 (0.88–1.27) for CHD

b1.07 (0.78–1.45) for IS

b1.05 (0.89–1.23) for CVD

highest vs lowest quartile

Vallejo-Vaz et al. (81)20189993Treating to New TargetsFastingCalculated as non-HDL-C minus LDL-CComposite: MI, total stroke, resuscitated cardiac arrest, and CVD death

Atorvastatin 10 mg: 1.48 (1.15–1.92)

Atorvastatin 80 mg: 1.01 (0.76–1.34)

highest vs lowest quintile

Varbo A et al. (82)2019102 964Copenhagen General Population StudyNonfastingCalculated as TC minus HDL-C minus LDL-CIS

1.99 (1.49–2.67)

highest vs lowest quartile

Duran EK et al. (68)2020

976

(Case-Cohort)

Women’s Health Study (N = 27 552)NonfastingDirect homogenous assay for TRL-C, second generationComposite: MI, IS, PAD, and CVD death

1.97 (95% CI: 1.26–3.08)

highest vs lowest quartile

a

Adjusted for clinical risk factors.

b

Some studies present only models additionally adjusted for TG and/or HDL-C.

Abbreviations: HR, hazards ratio; OR, odds ratio; CAD, coronary artery disease; MI, myocardial infarction; TIA, transient ischemic attack; TS, total stroke; IS, ischemic stroke; ICH, intracranial hemorrhage; PAD, peripheral artery disease; CHD, coronary heart disease; CVD, cardiovascular disease; TC, total cholesterol; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; VLDL, very low-density-lipoprotein cholesterol; IDL-C, intermediate-density lipoprotein cholesterol; TRL, triglyceride-rich lipoproteins; VAP, vertical auto profile; NMR, nuclear magnetic resonance.

Table 1

Major prospective studies of remnant cholesterol and incident cardiovascular disease.

AuthorYear publishedSample sizeStudy settingFasting statusMeasurementOutcomeAdjustedarisk association
HR or OR (95% CI)
Phillips NR et al. (70)1993335Montreal Heart StudyFastingUltracentrifugation: IDL-C+VLDL-CComposite: MI, coronary revascularization, cardiac death1.02b (1.01–1.03) per 1 mg/dL increase
Kugiyama K et al. (71)1999147Patients with Angiographic CADFasting

Immunoseparation

remnant TRL-C

Composite: MI, recurrent, or refractory angina requiring coronary revascularization, cardiac death

6.38b (2.3–17.6)

highest vs lowest tertile

McNamara JR et al. (72)20011567Framingham Heart Study, WomenFasting

Immunoseparation

remnant TRL-C

Composite: angina, MI, TS, TIA

2.27b (1.37–3.77)

highest quartile vs all others

Fukushima H et al. (73)2004120Patients with Angiographic CAD and DiabetesFasting

Immunoseparation

remnant TRL-C

Composite: MI, refractory angina requiring coronary revascularization, cardiac death

2.2b (1.2–6.4)

highest quartile vs all others

Imke C et al. (74)20051156Japanese-American MenFasting

Immunoseparation

remnant TRL-C

Composite: MI, revascularization, sudden death

Normal TG: 1.009 (0.939–1.085)

High TG: 1.011 (1.001–1.021)

per mg/dl

Mora S et al. (75)200927 673Women’s Health StudyNonfastingNMR small, medium, large, and total VLDL particle concentrationComposite: MI, IS, coronary revascularization, CVD death

Small VLDL: 1.56 (1.27–1.91)

Medium VLDL: 1.46 (1.17–1.82)

Large VLDL: 1.77 (1.34–2.33)

Total VLDL: 1.71 (1.38–2.12)

highest vs lowest quintile

Varbo A et al. (76)201373 513Copenhagen General Population Study, Copenhagen City Heart Study, and Copenhagen Ischemic Heart Disease StudyNonfastingCalculated as TC minus HDL-C minus LDL-CIschemic heart disease

2.3 (1.7–3.1)

highest vs lowest quintile

Joshi PH et al. (77)20164114

Jackson Heart Study,

Black Participants

FastingVAP: VLDL3 plus IDL-CComposite: MI, CHD death, revascularization1.18 (1.00–1.39) per SD increase
Joshi PH et al. (77)2016818Framingham Offspring Cohort StudyFastingVAP: VLDL3 plus IDL-CComposite: MI, CHD death, revascularization1.46 (1.05–2.04) per SD increase
Lawler P et al. (78)201711 984Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER)NonfastingNMR small, medium, large, and total VLDL particle concentrationComposite: MI, stroke, hospitalization for unstable angina, arterial revascularization, and CVD death

Small VLDL: 1.16 (0.99–1.36)

Medium VLDL: 1.30 (1.10–1.53)

Large VLDL: 1.17 (1.00–1.37)

Total VLDL: 1.21 (1.04–1.41)

per SD increase

Varbo A et al. (67)2018106 216Copenhagen General Population Study, Stratified by WeightNonfastingCalculated as TC minus HDL-C minus LDL-CMI

Normal Weight: 2.0 (1.3–3.2)

Overweight: 1.9 (1.4–2.6)

Obese: 2.3 (1.4–3.5)

highest vs lowest quartile

Aday A et al. (79)201827 888Women’s Health StudyNonfastingNMR very small, small, medium, large, very large, and total VLDL particle concentrationPAD

Very Small VLDL: 1.01 (0.61–1.67)

Small VLDL: 0.99 (0.62–1.59)

Medium VLDL: 1.98 (1.15–3.41)

Large VLDL: 1.58 (0.94–2.68)

Very Large VLDL: 1.68 (1.05–2.55)

Total VLDL: 1.39 (0.81–2.38)

highest vs lowest tertile

Holmes M et al. (80)2018

4662

(Nested Case-Control)

Chinese Kadoorie Biobank (N = 512 891)NonfastingNMR metabolomics remnant cholesterol (VLDL-C plus IDL-C)MI, IS individually

1.27 (1.15–1.39) for MI

1.20 (1.09–1.32) for IS

per SD increase

Saeed A et al. (69)20189334Atherosclerosis Risk in Communities StudyFasting

Direct homogenous assay for TRL-C,

first generation

CHD, IS, CVD individually

b1.06 (0.88–1.27) for CHD

b1.07 (0.78–1.45) for IS

b1.05 (0.89–1.23) for CVD

highest vs lowest quartile

Vallejo-Vaz et al. (81)20189993Treating to New TargetsFastingCalculated as non-HDL-C minus LDL-CComposite: MI, total stroke, resuscitated cardiac arrest, and CVD death

Atorvastatin 10 mg: 1.48 (1.15–1.92)

Atorvastatin 80 mg: 1.01 (0.76–1.34)

highest vs lowest quintile

Varbo A et al. (82)2019102 964Copenhagen General Population StudyNonfastingCalculated as TC minus HDL-C minus LDL-CIS

1.99 (1.49–2.67)

highest vs lowest quartile

Duran EK et al. (68)2020

976

(Case-Cohort)

Women’s Health Study (N = 27 552)NonfastingDirect homogenous assay for TRL-C, second generationComposite: MI, IS, PAD, and CVD death

1.97 (95% CI: 1.26–3.08)

highest vs lowest quartile

AuthorYear publishedSample sizeStudy settingFasting statusMeasurementOutcomeAdjustedarisk association
HR or OR (95% CI)
Phillips NR et al. (70)1993335Montreal Heart StudyFastingUltracentrifugation: IDL-C+VLDL-CComposite: MI, coronary revascularization, cardiac death1.02b (1.01–1.03) per 1 mg/dL increase
Kugiyama K et al. (71)1999147Patients with Angiographic CADFasting

Immunoseparation

remnant TRL-C

Composite: MI, recurrent, or refractory angina requiring coronary revascularization, cardiac death

6.38b (2.3–17.6)

highest vs lowest tertile

McNamara JR et al. (72)20011567Framingham Heart Study, WomenFasting

Immunoseparation

remnant TRL-C

Composite: angina, MI, TS, TIA

2.27b (1.37–3.77)

highest quartile vs all others

Fukushima H et al. (73)2004120Patients with Angiographic CAD and DiabetesFasting

Immunoseparation

remnant TRL-C

Composite: MI, refractory angina requiring coronary revascularization, cardiac death

2.2b (1.2–6.4)

highest quartile vs all others

Imke C et al. (74)20051156Japanese-American MenFasting

Immunoseparation

remnant TRL-C

Composite: MI, revascularization, sudden death

Normal TG: 1.009 (0.939–1.085)

High TG: 1.011 (1.001–1.021)

per mg/dl

Mora S et al. (75)200927 673Women’s Health StudyNonfastingNMR small, medium, large, and total VLDL particle concentrationComposite: MI, IS, coronary revascularization, CVD death

Small VLDL: 1.56 (1.27–1.91)

Medium VLDL: 1.46 (1.17–1.82)

Large VLDL: 1.77 (1.34–2.33)

Total VLDL: 1.71 (1.38–2.12)

highest vs lowest quintile

Varbo A et al. (76)201373 513Copenhagen General Population Study, Copenhagen City Heart Study, and Copenhagen Ischemic Heart Disease StudyNonfastingCalculated as TC minus HDL-C minus LDL-CIschemic heart disease

2.3 (1.7–3.1)

highest vs lowest quintile

Joshi PH et al. (77)20164114

Jackson Heart Study,

Black Participants

FastingVAP: VLDL3 plus IDL-CComposite: MI, CHD death, revascularization1.18 (1.00–1.39) per SD increase
Joshi PH et al. (77)2016818Framingham Offspring Cohort StudyFastingVAP: VLDL3 plus IDL-CComposite: MI, CHD death, revascularization1.46 (1.05–2.04) per SD increase
Lawler P et al. (78)201711 984Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER)NonfastingNMR small, medium, large, and total VLDL particle concentrationComposite: MI, stroke, hospitalization for unstable angina, arterial revascularization, and CVD death

Small VLDL: 1.16 (0.99–1.36)

Medium VLDL: 1.30 (1.10–1.53)

Large VLDL: 1.17 (1.00–1.37)

Total VLDL: 1.21 (1.04–1.41)

per SD increase

Varbo A et al. (67)2018106 216Copenhagen General Population Study, Stratified by WeightNonfastingCalculated as TC minus HDL-C minus LDL-CMI

Normal Weight: 2.0 (1.3–3.2)

Overweight: 1.9 (1.4–2.6)

Obese: 2.3 (1.4–3.5)

highest vs lowest quartile

Aday A et al. (79)201827 888Women’s Health StudyNonfastingNMR very small, small, medium, large, very large, and total VLDL particle concentrationPAD

Very Small VLDL: 1.01 (0.61–1.67)

Small VLDL: 0.99 (0.62–1.59)

Medium VLDL: 1.98 (1.15–3.41)

Large VLDL: 1.58 (0.94–2.68)

Very Large VLDL: 1.68 (1.05–2.55)

Total VLDL: 1.39 (0.81–2.38)

highest vs lowest tertile

Holmes M et al. (80)2018

4662

(Nested Case-Control)

Chinese Kadoorie Biobank (N = 512 891)NonfastingNMR metabolomics remnant cholesterol (VLDL-C plus IDL-C)MI, IS individually

1.27 (1.15–1.39) for MI

1.20 (1.09–1.32) for IS

per SD increase

Saeed A et al. (69)20189334Atherosclerosis Risk in Communities StudyFasting

Direct homogenous assay for TRL-C,

first generation

CHD, IS, CVD individually

b1.06 (0.88–1.27) for CHD

b1.07 (0.78–1.45) for IS

b1.05 (0.89–1.23) for CVD

highest vs lowest quartile

Vallejo-Vaz et al. (81)20189993Treating to New TargetsFastingCalculated as non-HDL-C minus LDL-CComposite: MI, total stroke, resuscitated cardiac arrest, and CVD death

Atorvastatin 10 mg: 1.48 (1.15–1.92)

Atorvastatin 80 mg: 1.01 (0.76–1.34)

highest vs lowest quintile

Varbo A et al. (82)2019102 964Copenhagen General Population StudyNonfastingCalculated as TC minus HDL-C minus LDL-CIS

1.99 (1.49–2.67)

highest vs lowest quartile

Duran EK et al. (68)2020

976

(Case-Cohort)

Women’s Health Study (N = 27 552)NonfastingDirect homogenous assay for TRL-C, second generationComposite: MI, IS, PAD, and CVD death

1.97 (95% CI: 1.26–3.08)

highest vs lowest quartile

a

Adjusted for clinical risk factors.

b

Some studies present only models additionally adjusted for TG and/or HDL-C.

Abbreviations: HR, hazards ratio; OR, odds ratio; CAD, coronary artery disease; MI, myocardial infarction; TIA, transient ischemic attack; TS, total stroke; IS, ischemic stroke; ICH, intracranial hemorrhage; PAD, peripheral artery disease; CHD, coronary heart disease; CVD, cardiovascular disease; TC, total cholesterol; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; VLDL, very low-density-lipoprotein cholesterol; IDL-C, intermediate-density lipoprotein cholesterol; TRL, triglyceride-rich lipoproteins; VAP, vertical auto profile; NMR, nuclear magnetic resonance.

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