Remnant cholesterol, plasma triglycerides, and risk of cardiovascular disease events in young adults: a prospective cohort study

Abstract Aims This study aims to investigate if elevated levels of cholesterol carried in triglyceride-rich lipoproteins, marked by remnant cholesterol or plasma triglycerides, are associated with increased risk of premature cardiovascular disease (CVD) events in young adults. Methods and results This study is a prospective cohort study. In the year 2000, all 30-year-old inhabitants living in Oslo, Norway, were invited to the ‘Oslo Health Study’ including a clinical examination and routine blood tests. Follow-up with respect to CVD events (cardiovascular death, non-fatal myocardial infarction, non-fatal ischaemic stroke, coronary revascularization, or hospitalization for unstable angina) was obtained by linkage with national mandatory registries through 2022. We estimated the risk of CVD events in relation to levels of remnant cholesterol and plasma triglycerides at inclusion using Cox regression analysis. The risk of CVD events in relation to LDL cholesterol (LDL-C) levels was estimated as comparison. A total of 5939 participants were included (median age 31 years, 56% women). During a median follow-up time of 22 years, a CVD event occurred in 107 (1.8%) participants. The adjusted hazard ratio (aHR) for CVD events per 0.5 mmol/L increase in remnant cholesterol concentrations was 1.3 [95% confidence interval (CI): 1.1–1.5]. Per 1 mmol increase in plasma triglycerides and LDL-C concentrations, the aHR for CVD events was 1.2 (95% CI: 1.1–1.4) and 1.3 (95% CI: 1.1–1.6), respectively. Conclusion Already at 31 years of age, higher concentrations of remnant cholesterol and plasma triglycerides were associated with increased risk of premature CVD events. We suggest that remnant cholesterol or plasma triglycerides are included in the risk assessment of young adults.