The relation between VLDL-cholesterol and risk of cardiovascular events in patients with manifest cardiovascular disease

Britt E. Heidemann, Charlotte Koopal, Michiel L. Bots, Folkert W. Asselbergs, Jan Westerink, Frank L.J. Visseren*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Introduction: Apolipoprotein B containing lipoproteins are atherogenic. There is evidence that with low plasma low density lipoprotein cholesterol (LDL-C) levels residual vascular risk might be caused by triglyceride rich lipoproteins such as very-low density lipoproteins (VLDL), chylomicrons and their remnants. We investigated the relationship between VLDL-cholesterol (VLDL-C) and recurrent major adverse cardiovascular events (MACE), major adverse limb events (MALE) and all-cause mortality in a cohort of patients with cardiovascular disease. Methods: Prospective cohort study in 8057 patients with cardiovascular disease from the UCC-SMART study. The relation between calculated VLDL-C levels and the occurrence of MACE, MALE and all-cause mortality was analyzed with Cox regression models. Results: Patients mean age was 60 ± 10 years, 74% were male, 4894 (61%) had coronary artery disease, 2445 (30%) stroke, 1425 (18%) peripheral arterial disease and 684 (8%) patients had an abdominal aorta aneurysm at baseline. A total of 1535 MACE, 571 MALE and 1792 deaths were observed during a median follow up of 8.2 years (interquartile range 4.512.2). VLDL-C was not associated with risk of MACE or all-cause mortality. In the highest quartile of VLDL-C the risk was higher for major adverse limb events (MALE) (HR 1.49; 95%CI 1.16–1.93) compared to the lowest quartile, after adjustment for confounders including LDL-C and lipid lowering medication. Conclusion: In patients with clinically manifest cardiovascular disease plasma VLDL-C confers an increased risk for MALE, but not for MACE and all-cause mortality, independent of established risk factors including LDL-C and lipid-lowering medication.

Original languageEnglish
Pages (from-to)251-257
Number of pages7
JournalInternational Journal of Cardiology
Publication statusPublished - 1 Jan 2021


  • Inflammation
  • Major adverse cardiovascular events
  • Non-HDL-C
  • Triglyceride rich lipoproteins
  • Vascular disease
  • VLDL-C


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