Remnant Cholesterol Links Lifestyle to Heart Disease Risk

TOPLINE: 

Individuals with unhealthy lifestyles, including a current smoking status, low physical activity, and low adherence to dietary guidelines, showed elevated levels of remnant cholesterol, which partly explained the excess risks for myocardial infarction (MI) and coronary heart disease (CHD).

METHODOLOGY:

• Researchers used data from a prospective cohort of a Danish general population study (2003-2015) to investigate whether elevated levels of remnant cholesterol explain the excess risks for MI and CHD in individuals with unhealthy lifestyles.
• They included 104,867 individuals (median age, 57.74 years; 55.6% women) who were free from coronary artery disease at examination.
• Lifestyle factors such as smoking, physical activity (low if less than 4 hours of light-intensity activity or less than 2 hours of high-intensity activity per week), alcohol intake (high if more than 120 g weekly), and dietary adherence (non-adherence defined as low intake of fruits, vegetables, and fish and high intake of saturated fat, sucrose, fast food, and cold meat cuts) were evaluated.
• Remnant cholesterol was calculated by subtracting low-density and high-density lipoprotein cholesterol from total cholesterol.
• The primary endpoint was the development of MI and CHD over a median follow-up of 9.2 years.

TAKEAWAY:

• Individuals with a current smoking status, low physical activity, low dietary adherence, and low alcohol intake had higher risks for MI (adjusted hazard ratio [aHR], 2.85; 95% CI, 2.23-3.64) and CHD (aHR, 2.53; 95% CI, 2.04-3.13) than those with healthier lifestyle behaviours.
• Current smoking, low physical activity, and low adherence to dietary guidelines were all associated with elevated levels of remnant cholesterol.
• For current smoking, remnant cholesterol explained 15% (95% CI, 9.7%-20%) of the excess risk for MI and 16% (95% CI, 11%-21%) of the excess risk for CHD.
• For low physical activity, remnant cholesterol explained 20% (95% CI, 13%-27%) of the excess risk for MI and 21% (95% CI, 15%-28%) of the excess risk for CHD, and the corresponding values for low adherence to dietary guidelines were 12% (95% CI, 6.6%-18%) and 14% (95% CI, 8%-19%), respectively.

IN PRACTICE:

“Ideally, elevated remnant cholesterol due to unhealthy lifestyle should be corrected by improvement of lifestyle, including recommendations to stop smoking, increase physical activity, and to increase intake of fruit and vegetables, to use unsaturated fat instead of saturated fat for warm and cold meals, to increase intake of fish, and to reduce intake of sugar, refined carbohydrates, and fast food,” the authors wrote.

SOURCE:

This study was led by Mia Ø Johansen, from Copenhagen University Hospital, Herlev and Gentofte, Denmark. It was published online on February 7, 2025, in The Lancet Regional Health – Europe.

LIMITATIONS: 

This study did not assess causality between exposure, mediator, and outcomes. The dietary assessment relied on a short and simple food frequency questionnaire. The study focused on White adults of Danish descent and was conducted in a high-income country with universal healthcare access, thereby limiting its generalisability.

DISCLOSURES:

This study was funded by the Independent Research Fund Denmark, Johan Boserup and Lise Boserups Grant, and Medical Research Council. One author reported receiving sponsorship for talks and consultancies from several pharmaceutical companies and serving as President-Elect of the European Atherosclerosis Society. Two other authors reported having financial ties with pharmaceutical companies. Other authors reported no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.