J Thromb Thrombolysis. 2026 Oct 25. doi: 10.1007/s11239-026-03421-1. Online ahead of print.
ABSTRACT
Remnant cholesterol (RC) is considered a contributor to residual cardiovascular risk, but whether its associations with specific cardiovascular outcomes vary according to the burden of traditional cardiovascular risk factors (CVRFs) remains uncertain. We investigated the associations of RC with myocardial infarction (MI) and stroke in relation to cumulative CVRF burden. We conducted a prospective analysis of 84,806 participants from the Kailuan cohort (baseline 2006) without prior cardiovascular disease. CVRF burden was categorized as 0, 1, 2, or ≥ 3 according to current smoking, overweight (BMI ≥ 24 kg/m²), hypertension, and diabetes. Cox proportional hazards models were used to estimate hazard ratios (HRs) for incident MI and stroke through 2021, and interaction terms were used to assess potential effect modification by CVRF burden. During a median follow-up of 15 years, 1,690 MI and 6,416 stroke events occurred. Compared with the lowest quartile, the highest RC quartile was associated with higher risks of MI (HR, 1.59; 95% CI, 1.37-1.83) and stroke (HR, 1.19; 95% CI, 1.11-1.28). In supplementary subtype analyses, the stroke association was mainly observed for ischemic rather than hemorrhagic stroke. The RC-MI association appeared stronger across higher CVRF-burden categories (highest vs. lowest quartile HRs: 1.16, 1.52, 1.67, and 1.80 for 0, 1, 2, and ≥ 3 CVRFs, respectively), whereas the corresponding stroke association was attenuated (HRs: 1.44, 1.29, 1.21, and 1.03). After noncardiovascular death was treated as a competing event, the stroke interaction was attenuated and no longer statistically significant (P for interaction=0.21). In this large prospective cohort, RC was associated with higher risks of both MI and stroke, with stronger and more consistent associations observed for MI. The pattern of association differed across levels of CVRF burden, suggesting that the clinical interpretation of RC may benefit from outcome-specific and risk-context-specific assessment.
PMID:42927564 | DOI:10.1007/s11239-026-03421-1