Beyond LDL Cholesterol: Value of non-HDL Cholesterol as a Predictor of Atherosclerotic Cardiovascular Events in Patients with ST-segment Elevation Myocardial Infarction

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Abstract

Background: In cardiovascular disease (CVD), lowering low-density lipoprotein cholesterol (LDL-C) remains the primary therapeutic goal to reduce major adverse cardiovascular events (MACE). Evidence from intervention studies shows that reducing LDL-C by at least 50% from baseline significantly decreases MACE risk. However, in clinical practice, even when target LDL-C levels are achieved, a residual risk persists, leaving patients vulnerable to recurrent events. Non-HDL cholesterol (cholesterol not associated with high-density lipoproteins, non-HDL-C) comprises all plasma lipoproteins except HDL-C, and denotes the serum cholesterol of all lipoproteins carrying apolipoprotein B.

Objective: To determine the role of non-HDL-C and remnant cholesterol (RC) as predictors of recurrent atherosclerotic cardiovascular events in patients with ST-segment elevation myocardial infarction (STEMI).  

Methods: We conducted a retrospective cohort study at a high-complexity center in the city of Buenos Aires. The data analyzed were obtained from an institutional database.  Follow-up was performed through the review of electronic medical records. Kaplan–Meier survival curves and Cox regression models were used for MACE prediction. A p-value < 0.05 was considered statistically significant.

Results: A total of 403 patients were included. During the first year of follow-up, MACE occurred in 23.5% (n=95) of patients, most frequently within the first 3 months. Patients with MACE had higher non-HDL-C (102 mg/dL vs. 84 mg/dL, p<0.001) and RC (29 mg/dL vs. 22 mg/dL, p<0.001) levels, with no significant differences in LDL-C

Conclusion: In this study, both non-HDL-C and RC were independent predictors of MACE after adjustment for LDL-C.