Prevention & lipidsRandomised controlled trial
Remnant cholesterol lowering in cardiovascular disease risk reduction in statin, ezetimibe, and PCSK9 inhibitor trials: meta-regression analyses
- Meta-regression analysis of randomised trials
- fixed and random effects
Authors' conclusion
Remnant cholesterol lowering is associated with part of the cardiovascular risk reduction in statin, ezetimibe, and PCSK9 inhibitor trials.
Study context
- Population
- Statin, ezetimibe and PCSK9 inhibitor trials of ≥1,000 participants with lipid level data
- Participants
- 327,264 participants · 43 trials
- Comparison
- Remnant cholesterol reduction vs LDL-C reduction as predictors of MACE
- Primary endpoint
- RR for MACE per 1 mmol/L (39 mg/dL) and per 1 SD reduction in LDL-C and remnant cholesterol
- Follow-up
- Lipid reductions at year one
Primary result
As reported in the abstract
MACE per 1 mmol/L reduction (meta-regression)
Relative risk (95% CI)
LDLfixed effects
0.84(0.82–0.85)
LDLrandom effects
0.82(0.78–0.85)
remnant cholesterolfixed effects
0.36(0.33–0.40)
remnant cholesterolrandom effects
0.27(0.20–0.36)
Per 1 mmol/L reduction, as printed
Further findings
| Outcome | RR (95% CI) | |
|---|---|---|
| MACE per 1 mmol/L reduction, mutually adjusted — LDL cholesterol · fixed effects; adjusted for remnant cholesterol reductions | 0.88 (0.85–0.91) | |
| MACE per 1 mmol/L reduction, mutually adjusted — LDL cholesterol · random effects; adjusted for remnant cholesterol reductions | 0.82 (0.74–0.91) | |
| MACE per 1 mmol/L reduction, mutually adjusted — remnant cholesterol · fixed effects; adjusted for LDL cholesterol reductions | 0.74 (0.60–0.92) | |
| MACE per 1 mmol/L reduction, mutually adjusted — remnant cholesterol · random effects; adjusted for LDL cholesterol reductions | 0.92 (0.45–1.187) | |
| 0.512Relative risk (log scale) |
MACE per 1 SD reduction (fixed/random effects RR, 95% CI)
- Low-density lipoprotein (LDL) cholesterol per 1 SD reduction
- 0.93 (0.92-0.93)/0.91 (0.90-0.93)
- Remnant cholesterol per 1 SD reduction
- 0.92 (0.92-0.93)/0.90 (0.88-0.92)
MACE per 1 SD reduction, mutually adjusted (fixed/random effects RR, 95% CI)
- LDL cholesterol adjusted for remnant cholesterol, per 1 SD
- 0.94 (0.93-0.96)/0.92 (0.88-0.96)
- Remnant cholesterol adjusted for LDL cholesterol, per 1 SD
- 0.98 (0.96-0.99)/0.99 (0.94-1.05)
Remnant cholesterol reduction relative to LDL-C reduction
- Remnant cholesterol reduced per 1 mmol/L LDL-C reduction
- 0.19 mmol/L
- Remnant cholesterol reduced per 20% LDL-C reduction
- 11%
Original publication
Remnant cholesterol lowering in cardiovascular disease risk reduction in statin, ezetimibe, and PCSK9 inhibitor trials: meta-regression analyses. Eur J Prev Cardiol. Published 12 June 2025. doi:10.1093/eurjpc/zwaf337
Summarised from the published abstract; every number is checked against it