Remnant cholesterol as a risk factor for cardiovascular, cancer or other causes mortality: A competing risks analysis

Caterina Bonfiglio, Carla M. Leone, Liciana V.A. Silveira, Rocco Guerra, Giovanni Misciagna, Maria G. Caruso, Irene Bruno, Claudia Buongiorno, Angelo Campanella, Vito M.B. Guerra, Maria Notarnicola, Valentina Deflorio, Isabella Franco, Antonella Bianco, Antonella Mirizzi, Laura R. Aballay, Anna M. Cisternino, Paolo Sorino, Pasqua L. Pesole, Alberto R. Osella

Research output: Contribution to journalArticlepeer-review


Background and aims: Cardiovascular diseases (CVDis) are leading causes of morbidity and mortality. Even after the introduction of pharmacological therapy to lower Cholesterol, there is still a residual risk that may be ascribed to remnant cholesterol (RC). We aimed, by analyzing two prospective cohort studies, to estimate the effect of RC on risk and hazard of cardiovascular deaths (CVDs), while accounting for competing risks such as cancer (CDs) and other-causes deaths (OCDs). Methods and results: Cohorts were enrolled in 1992 and 2005. Personal data history was recorded. A fasting venous blood sample was obtained, and RC was calculated at baseline. Cause of Death was coded by using ICD-10th version. Follow-up ended on December 31, 2017. Flexible parametric competing-risks models were applied, with age at death as time-axis. In total, 5729 subjects were enrolled. There were 861 (15.1%) deaths: 234 CVDs (27.2%), 245 CDs (28.5%), 271 OCDs (31.5%) and 111 unknown causes of death (12.8%). RC exposure was a strong risk factor only for CVDs (Risk 2.54, 95% Confidence Interval 1.21; 5.34; Trend 1.26 (1.00; 1.58) for ≥1.29 mmol/L). Conclusions: RC is a strong independent risk factor for cardiovascular mortality. Competing risk analysis is demonstrably a useful tool to disentangle associations among different competing events with a common risk factor.

Original languageEnglish
Pages (from-to)2093-2102
Number of pages10
JournalNutrition, Metabolism and Cardiovascular Diseases
Issue number11
Publication statusPublished - Oct 30 2020


  • Cause-specific mortality
  • Competing-risks
  • Remnant cholesterol
  • Survival analysis

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics
  • Cardiology and Cardiovascular Medicine


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