Are remnant-like particles independent predictors of coronary heart disease incidence? The Honolulu Heart Study

Background - Remnant- like particles have been proposed as a new risk factor for coronary heart disease ( CHD). This is the first long- term prospective investigation of the relationship between remnant- like particles and a cardiovascular disease outcome in healthy men. Methods and Results - A cohort of 1156 Japanese- American men aged 60 to 82 from the Honolulu Heart Program was followed for 17 years. During that period 164 incident cases of CHD were identified. In multivariate Cox regression analyses, baseline remnant- like particle cholesterol ( RLP- C) and triglyceride ( RLP- TG) levels were significantly related to CHD incidence independently of nonlipid cardiovascular risk factors and of total cholesterol or high- density and low- density lipoprotein cholesterol levels. Total triglyceride levels were an independent predictor of CHD incidence. However, in models including RLP and triglyceride level simultaneously, neither variable was significant when adjusted for the other. This finding can be attributed to the strong correlation between RLP- C and RLP- TG levels and total triglycerides. When individuals with normal triglyceride levels ( n = 894) were separated from those with elevated triglycerides ( n = 260), the association between RLPs and CHD relative risk was only significant for the group with elevated triglyceride levels. Conclusions - RLP levels predicted CHD incidence independently of nonlipid risk factors and of total cholesterol or high- density and low- density lipoprotein cholesterol levels. However, RLP levels did not provide additional information about CHD incidence over and above total triglyceride levels. Therefore, this study does not support the need for testing of remnants in men if measures of fasting triglycerides are available.