DOI: 10.1161/jaha.126.049077 ISSN: 2047-9980

Remnant Cholesterol Paradox: Higher Levels Are Associated With Reduced Mortality in Critically Ill Patients With Heart Failure

Zhiqiang Zhang, Yanbin Su, ShanShan Tang
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Background

Remnant cholesterol (RC) is a significant cardiovascular risk factor, but its prognostic value in critically ill patients with heart failure remains inadequately characterized. This study evaluated the association between RC levels and all‐cause mortality in this population.

Methods

This retrospective cohort study used data from 3750 critically ill patients with heart failure from the Medical Information Mart for Intensive Care III/IV databases. RC was calculated as total cholesterol minus high‐density and low‐density lipoprotein cholesterol. Optimal RC thresholds were determined by X‐tile: low (<22.7 mg/dL), intermediate (22.7–54.0 mg/dL), and high (≥54.0 mg/dL). Primary end points were 30‐day and 1‐year all‐cause mortality.

Results

Mortality occurred in 16.9% of patients at 30 days and 34.1% at 1 year. After multivariable adjustment, each 10 mg/dL increment in RC was associated with reduced risks of 30‐day (hazard ratio [HR], 0.88 [95% CI, 0.82–0.95]) and 1‐year mortality (HR, 0.92 [95% CI, 0.88–0.97]). Compared with the low RC group, the high RC group exhibited significant reductions in 30‐day (HR, 0.52 [95% CI, 0.31–0.87]) and 1‐year mortality (HR, 0.61 [95% CI, 0.44–0.8]7). Restricted cubic spline analysis confirmed a linear inverse relationship.

Conclusions

Higher RC levels are independently associated with lower all‐cause mortality in critically ill patients with heart failure. These findings suggest a protective, context‐dependent role of RC during acute illness.

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