Association Between Remnant Cholesterol and Risk of Incident Atrial Fibrillation: Population‐Based Evidence From a Large‐Scale Prospective Cohort Study

Background Evidence for the relationship between remnant cholesterol (RC) and incident atrial fibrillation (AF) risk remains sparse and limited. Methods and Results Participants were enrolled between 2006 and 2010 and followed up to 2021. The multivariable Cox proportional hazards model was used to examine the relationship between RC quartiles and risk of incident AF. Subgroup analyses and sensitivity analyses were performed to explore the potential modification of the association and the robustness of the main findings. A total of 422 316 participants (mean age, 56 years; 54% women) were included for analyses. During a median follow‐up of 11.9 years (first quartile–third quartile, 11.6–13.2 years), there were 24 774 AF events documented with an incidence of 4.92 events per 1000 person‐years (95% CI, 4.86–4.98). Participants in higher RC quartiles had a lower risk of incident AF than those in the lowest quartile (first quartile): hazard ratio (HR)=0.96 (95% CI, 0.91–1.00) for second quartile; HR=0.92 (95% CI, 0.88–0.96) for third quartile; and HR=0.85 (95% CI, 0.81–0.89) for fourth quartile ( P for trend <0.001). The association between RC quartiles and risk of incident AF was stronger in participants aged ≥65 years, in men, and in participants without history of diabetes when compared with control groups ( P <0.001 for interaction). Conclusions On the basis of data from this large‐scale prospective cohort study, elevated RC was associated with a lower risk of incident AF.