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. 2025 Mar 26;14(7):2260.
doi: 10.3390/jcm14072260.

Remnant Cholesterol Levels at Diagnosis May Predict Acute Coronary Syndrome Occurrence During Follow-Up in Patients with Antineutrophil Cytoplasmic Antibody-Associated Vasculitis

Hyunsue Do  1 , Oh Chan Kwon  2 , Jang Woo Ha  3 , Jihye Chung  4 , Yong-Beom Park  4   5 , Ji Hye Huh  6 , Sang-Won Lee  4   5
Affiliations

Remnant Cholesterol Levels at Diagnosis May Predict Acute Coronary Syndrome Occurrence During Follow-Up in Patients with Antineutrophil Cytoplasmic Antibody-Associated Vasculitis

Hyunsue Do et al. J Clin Med. .

Abstract

Background/Objectives: Previous studies have revealed the predictive potential of remnant cholesterol (RC) for acute coronary syndrome (ACS) occurrence in the general population. However, whether this association applies to patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV), in which a lipid paradox exists, remains unclear. We investigated whether RC levels at diagnosis could predict ACS occurrence during follow-up in patients with AAV. Methods: This study included 139 patients with AAV. ACS was defined as ST-elevation myocardial infarction (STEMI), non-STEMI, or unstable angina occurring after AAV diagnosis. RC levels were calculated as (total cholesterol)-(low-density lipoprotein cholesterol)-(high-density lipoprotein cholesterol). Patients were categorised into three groups by RC tertiles: highest (≥26.2 mg/dL), middle (19.1-26.1 mg/dL), and lowest (≤19.0 mg/dL) tertile groups. Results: The median age of the 139 patients (male, 31.7%) was 58.0 years. During follow-up, six, two, and one patients were diagnosed with ACS in the highest, middle, and lowest tertile groups, respectively. Patients in the highest tertile group exhibited a significantly lower ACS-free survival rate than those in the lowest tertile (p = 0.030). In the multivariable Cox hazards model, male sex (hazard ratio [HR] 9.054, 95% confidence interval [CI] 1.786-45.910), Birmingham vasculitis activity score (HR 1.147, 95% CI 1.033-1.274), and the highest tertile of RC levels (HR 10.818, 95% CI 1.867-62.689) were significantly and independently associated with ACS occurrence during follow-up in patients with AAV. Conclusions: Our findings indicate that RC levels at diagnosis may predict ACS occurrence during follow-up in patients with AAV, regardless of the traditional cardiovascular risk factors.

Keywords: acute coronary syndrome; antineutrophil cytoplasmic antibody; predict; remnant cholesterol; vasculitis.

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Conflict of interest statement

The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Area under the curve and relative risk for ACS. (A–C) Among the three poor outcomes, the AUC of RC levels for ACS was significant in the ROC curve analysis. (D) Relative risk of the cut-off of RC levels of 26.2 mg/dL for ACS occurrence was 4.341. ACS: acute coronary syndrome; AUC: area under the curve; CVA: cerebrovascular vascular accident; RC: remnant cholesterol; ROC: receiver operating characteristic.
Figure 2
Figure 2
Tertile groups according to RC levels. The grey squares in the left panel represent the interquartile range. RC: remnant cholesterol; ACS: acute coronary syndrome.
Figure 3
Figure 3
Comparison of ACS-free survival rates. (A) The highest tertile group had a significantly lower ACS-free survival rate than the lowest tertile group. (B) The highest tertile group had a significantly lower ACS-free survival rate than the middle and lowest tertile groups. ACS: acute coronary syndrome; RC: remnant cholesterol.
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