Remnant cholesterol, which is calculated as total cholesterol minus LDL cholesterol minus HDL cholesterol has attracted interest as a marker of cardiovascular event risk. The power of remnant cholesterol to predict cardiovascular events in patients with established coronary artery disease (CAD) is unclear and is addressed in the present study. We enrolled 1350 consecutive patients with angiographically proven stable CAD. Prospectively, cardiovascular events were recorded over a mean follow-up period of 10.4±4.8 years. At baseline, remnant cholesterol was significantly higher in patients with T2DM (n=428) than in nondiabetic subjects (29±24 vs. 24±22 mg/dl; p<;0.001). During follow-up, 651 of our patients suffered cardiovascular events; the event rate was significantly higher in patients with T2DM than in nondiabetic subjects (56.9 vs. 44.9%; p<;0.001). Remnant cholesterol in Cox regression models adjusting for age, sex, hypertension, smoking, body mass index and LDL cholesterol independently predicted cardiovascular events in the total study population (standardized adjusted HR 1.15 [1.07-1.23]; p<;0.001), and in patients with T2DM as well as in nondiabetic subjects (standardized adjusted HRs 1.19 [1.05-1.35]; p=0.006 and 1.12 [1.02-1.23]; p=0.010, respectively). From our data we conclude that remnant cholesterol in patients with established CAD predicts cardiovascular events both among patients with T2DM and among nondiabetic subjects.


C.H. Saely: None. M. Maechler: None. A. Mader: None. B. Larcher: None. L. Sprenger: None. M. Klement: None. D. Purin: None. A. Leiherer: None. A. Muendlein: None. A. Vonbank: None. H. Drexel: None.

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