Predictive value of remnant cholesterol level for all-cause mortality in heart failure patients

BACKGROUND: Lower cholesterol levels are associated with increased mortality in heart failure (HF) patients. Remnant cholesterol corresponds to all cholesterol not found in high-density lipoprotein (HDL) and low-density lipoprotein (LDL). The prognostic role of remnant cholesterol in HF remains unknown. OBJECTIVE: To reveal the relationship between the baseline remnant cholesterol level and all-cause mortality in HF patients. METHODS: This study enrolled 2,823 patients hospitalized for HF. Kaplan–Meier analysis, Cox regression, C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to evaluate the prognostic value of remnant cholesterol for all-cause mortality in HF. RESULTS: The mortality rate was lowest in the fourth quartile of remnant cholesterol, which had an adjusted hazard ratio (HR) for death of 0.56 [HR: 0.39, 95% confidence interval (CI): 0.46–0.68, p < 0.001] relative to the first quartile. After adjustment, a one-unit increase in the level of remnant cholesterol was associated with a 41% decrease in the risk of all-cause mortality (HR: 0.59, 95% CI: 0.47–0.73, p < 0.001). A refinement in risk prediction was observed after adding remnant cholesterol quartile to the original model (ΔC-statistic = 0.010, 95% CI: 0.003–0.017; NRI = 0.036, 95% CI: 0.003–0.070; IDI = 0.025, 95% CI: 0.018–0.033; all p < 0.05). CONCLUSION: Low remnant cholesterol levels are associated with increased all-cause mortality in HF patients. The addition of the remnant cholesterol quartile improved the predictive value over traditional risk factors. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, Unique Identifier: NCT02664818.