Background and Aims The synergistic association of remnant cholesterol (remnant-C) and low-density lipoprotein cholesterol (LDL-C) levels with incident cardiovascular disease (CVD) in various subgroups of Koreans was investigated. Methods Using the national health insurance data, we included subjects aged between 40 and 70 without a history of CVD and at least two health screenings between 2009 and 2011. The subjects were divided into four groups by LDL-C and remnant-C levels. The primary outcome was CVD, which occurred between 2014 and 2017. Results Among 3,686,034 (45.6% women) of subjects, 144,004 cardiovascular events occurred. Individuals in both high LDL-C and high remnant-C [hazard ratio (HR) 1.266, 95% confidence interval (CI) 1.243–1.289; 7.9%], high LDL-C only (HR 1.098, 95% CI 1.083–1.113; 21.2%), and high remnant-C only groups (HR 1.102, 95% CI 1.087–1.118; 19.1%) had higher risks of CVD than the reference group (LDL-C < 3.4 mmol/L and remnant-C < 0.8 mmol/L; 51.8%). A continuous and linear increase in CVD risk was found in those with higher remnant-C levels after adjustment for several confounders, including LDL-C levels. The association of remnant-C ≥ 0.8 mmol/L with an increased CVD risk was consistent across various strata. Conclusions Combined high remnant-C and LDL-C levels confer a higher CVD risk than that individually. Elevated remnant-C values, independent of LDL-C levels, were associated with a risk of incident CVD. Remnant-C levels in addition to LDL-C levels are important considerations in risk stratification for the primary prevention of CVD.

Author's summary Although clinical tools for the diagnosis and treatment of heart failure (HF) have been developed, mortality and morbidity rates for HF remain steady, and optimal medical therapy rates remain low. This indicates that there is a gap between clinical practice and guidelines and highlights the importance of quality assessment of HF care. This review article examines HF treatment patterns and treatment adherence in real-world practice, identifies clinical gaps, suggests ways to improve the quality of care for HF, and finally aims to improves care and clinical outcomes for patients with HF.

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