Relationship Between Remnant Cholesterol and Risk of Heart Failure in a Community Population Without Cardiovascular Disease: Results of the China Patient‐Centered Evaluative Assessment of Cardiac Events Million Persons Project

Background The association between heart failure (HF) and remnant cholesterol (RC) has not been comprehensively elucidated. Methods This study assessed data from 90 280 individuals (mean age, 54 years; 61.2% women) in the China Patient‐Centered Evaluative Assessment of Cardiac Events Million Persons Project, all free of cardiovascular disease at baseline. RC was calculated by the equation: total cholesterol minus high‐density lipoprotein cholesterol minus low‐density lipoprotein cholesterol (LDL‐C), with low‐density lipoprotein cholesterol derived using the Friedewald equation. Cox proportional hazards model was used to examine the relationship of RC to HF risk. We also assessed the correlation between left ventricular structure and function and RC levels using multivariable linear regression models in 15 004 participants with echocardiographic data. Results The study had a median follow‐up period of 3.52 years and recorded 1105 new‐onset HF events. In multivariable models, every SD increment in RC was associated with a 7% increased risk of HF (hazard ratio [HR], 1.07 [95% CI, 1.01–1.13]), with a noted gradient of association. Even after accounting for interim myocardial infarction/coronary heart disease, individuals with high baseline RC (≥1.1 mmol/L) remained at a 24% greater HF risk (HR, 1.24 [95% CI, 1.05–1.46]) than the low group (<0.63 mmol/L). Each SD in the log‐transformed baseline RC increase was significantly correlated with increases in relative wall thickness (β=0.0014; P =0.01) and left ventricular mass index (β=0.45; P =0.01). Conclusions Elevated RC is linked to unfavorable left ventricular structure and function alterations, increasing the risk of subsequent HF. This association with HF appears to be independent of interim myocardial infarction/coronary heart disease.