Remnant cholesterol lowering in cardiovascular disease risk reduction in statin, ezetimibe, and PCSK9 inhibitor trials: meta-regression analyses

Topic: Brain proteins, microglia and lab models

A total of 43 trials of 327,264 participants with 42,016 major adverse cardiovascular events where included. Remnant cholesterol was reduced 0.19 mmol/L per 1 mmol/L LDL cholesterol reduction, and 11% per 20% LDL cholesterol reduction. Fixed/random effects risk ratios (95% confidence intervals) for major adverse cardiovascular events per 1 mmol/L reductions were 0.84 (0.82-0.85)/0.82 (0.78-0.85) for LDL and 0.36 (0.33-0.40)/0.27 (0.20-0.36) for remnant cholesterol. Corresponding, estimates per 1 standard deviation reductions were 0.93 (0.92-0.93)/0.91 (0.90-0.93) and 0.92 (0.92-0.93)/0.90 (0.88-0.92), respectively. Fixed/random effects risk ratios per 1 mmol/L reductions were 0.88 (0.85-0.91)/0.82 (0.74-0.91) for LDL cholesterol adjusted for remnant cholesterol reductions and 0.74 (0.60-0.92)/0.92 (0.45-1.187) for remnant cholesterol adjusted for LDL cholesterol reductions. Corresponding estimates per 1 standard deviation reductions were 0.94 (0.93-0.96)/0.92 (0.88-0.96) and 0.98 (0.96-0.99)/0.99 (0.94-1.05), respectively. Remnant cholesterol lowering is associated with part of the cardiovascular risk reduction in statin, ezetimibe, and PCSK9 inhibitor trials.

@article{nordestgaard2025-40504878,
  author  = {Nordestgaard, Ask Tybjærg and Nordestgaard, Børge Grønne},
  title   = {{Remnant cholesterol lowering in cardiovascular disease risk reduction in statin, ezetimibe, and PCSK9 inhibitor trials: meta-regression analyses}},
  journal = {European Journal of Preventive Cardiology},
  year    = {2025},
  doi     = {10.1093/eurjpc/zwaf337},
  pmid    = {40504878},
  url     = {https://doi.org/10.1093/eurjpc/zwaf337}
}

Key findings

• A total of 43 trials of 327,264 participants with 42,016 major adverse cardiovascular events where included.
• Remnant cholesterol was reduced 0.19 mmol/L per 1 mmol/L LDL cholesterol reduction, and 11% per 20% LDL cholesterol reduction.
• Fixed/random effects risk ratios (95% confidence intervals) for major adverse cardiovascular events per 1 mmol/L reductions were 0.84 (0.82-0.85)/0.82 (0.78-0.85) for LDL and 0.36 (0.33-0.40)/0.27 (0.20-0.36) for remnant cholesterol.
• Corresponding, estimates per 1 standard deviation reductions were 0.93 (0.92-0.93)/0.91 (0.90-0.93) and 0.92 (0.92-0.93)/0.90 (0.88-0.92), respectively.
• Fixed/random effects risk ratios per 1 mmol/L reductions were 0.88 (0.85-0.91)/0.82 (0.74-0.91) for LDL cholesterol adjusted for remnant cholesterol reductions and 0.74 (0.60-0.92)/0.92 (0.45-1.187) for remnant cholesterol adjusted for LDL cholesterol reductions.

Why it matters

This meta-regression is about cholesterol lowering and cardiovascular events, not Alzheimer's disease, and reports no findings on dementia. It found that lowering remnant cholesterol was associated with part of the cardiovascular risk reduction seen in statin, ezetimibe, and PCSK9 inhibitor trials.

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Study details

• Participants1,000
• Evidence strengthLow

Read the original

• DOI: 10.1093/eurjpc/zwaf337
• PubMed: 40504878
• Original source →

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