Background: Statins reduce LDL-C and cardiovascular risk in patients with atherosclerotic cardiovascular disease (ASCVD). However, in patients treated with statins, it is uncertain whether measures of triglyceride-rich lipoproteins (TRLs) predict risk.
Objectives and Methods: This study examined univariate and multivariate relationships of baseline fasting triglyceride or remnant cholesterol levels to the primary outcome (composite endpoint of cardiovascular death, myocardial infarction, stroke, coronary revascularization, or hospitalization for unstable angina) in the ACCELERATE trial of 12,092 ASCVD patients randomized to receive evacetrapib or placebo, and followed for a median of 26 months. 97% of patients were on statin therapy. Age, sex, hypertension, current smoking, diabetes, body mass index, and LDL-C were used as covariate.
Results: Fasting triglyceride levels were associated with cardiovascular risk only as a univariate [Table]. Remnant cholesterol levels were associated with cardiovascular risk both in univariate and multivariate models. However, remnant cholesterol levels predicted cardiovascular events only in patients with baseline LDL-C above the median level (78 mg/dL) [multivariate, 5th vs 1st quintile: LDL-C
Conclusions: Fasting remnant cholesterol levels predict cardiovascular risk in ASCVD patients with LDL-C above median and on standard of care including high-intensity statins. Remnant cholesterol is a reliable marker of TRLs and may be an important additional target for therapy. (A Study of Evacetrapib in High-Risk Vascular Disease [ACCELERATE]; NCT01687998) (N Engl J Med 2017 376:1933-1942)