AUTHOR=Loh Wann Jia , Soh Heng Samuel , Tun Mon Hnin , Tan Pei Ting , Lau Chin Shern , Tavintharan Subramaniam , Watts Gerald F. , Aw Tar Choon 

TITLE=Elevated remnant cholesterol and non-HDL cholesterol concentrations from real-world laboratory results: a cross-sectional study in Southeast Asians

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 11 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2024.1328618

DOI=10.3389/fcvm.2024.1328618

ISSN=2297-055X

ABSTRACT=Introduction: Triglyceride-rich remnant lipoproteins (TRLs) are atherogenic because of the remnant cholesterol content carried by apolipoprotein B. In clinical practice, the concentration of TRLs can be estimated by calculating remnant cholesterol or non-HDL.We aimed to investigate the proportion of patients with low LDL cholesterol concentration that have elevated remnant cholesterol concentration, stratified by the presence of hypertriglyceridemia and ethnicity, using real-world hospital data. Our secondary aim was to investigate the proportion of patients with elevated non-HDL using guidelinerecommended goals.Methods: A retrospective study of all patients with lipid blood tests including directly measured LDL-C in a single center over 2 years was conducted. Fasting for blood test was not mandatory.Results: 21,605 consecutive patients with plasma lipid profiles analyzed in our hospital laboratory were included. The median age was 61 years. In patients with ASCVD (n=14,704), 23.7% had LDL-C < 1.8 mmol/L, 11.3% had elevated remnant cholesterol concentration ≥ 0.65 mmol/L and 48.8% were at non-HDL-C goal (< 2.6mmol/L).In patients with ASCVD with LDL-C < 1.8 mmol/L (n=3484), only 11.9% with elevated remnant cholesterol concentration, but 96% of the patients with ASCVD also achieved the recommended non-HDL-C target of < 2.6 mmol/L. When LDL-C <1.8 mmol/L, the mean remnant cholesterol concentration was 0.214 mmol/L when triglyceride <1.7 mmol/L (n=3380), versus 0.70 mmol/L when triglyceride level was elevated (n=724), p <0.001.When triglyceride ≥ 1.7 mmol/L and LDL-C <1.8 mmol/L, there were 254 patients with elevated remnant cholesterol concentration, while 71 patients had suboptimal non-HDL. Malays had higher mean remnant cholesterol concentration compared with Chinese and Indians at all LDL-C levels, especially in the presence of hypertriglyceridemia.Conclusions: Elevated remnant cholesterol concentration of > 0.65 mmol/L was present in 11% of all patients. The current guideline-recommended non-HDL-C goal which uses a 0.8 mmol/L estimate of remnant cholesterol concentration was achieved in >92% of patients, suggesting that is unlikely to be clinically useful for majority of our patient population except where there was concomitant hypertriglyceridemia. Further studies are needed to establish the appropriate non-HDL-C goal or calculated remnant cholesterol concentration, paired with LDL-C goal or otherwise, in an Southeast Asian population.