{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:44:59Z","timestamp":1787237099033,"version":"build-2736575974"},"reference-count":25,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2015,10,13]],"date-time":"2015-10-13T00:00:00Z","timestamp":1444694400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["P50 HL 077113"],"award-info":[{"award-number":["P50 HL 077113"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T32HL07024"],"award-info":[{"award-number":["T32HL07024"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T32HL007227"],"award-info":[{"award-number":["T32HL007227"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100002429","name":"Amgen","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100002429","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001009","name":"Bristol-Myers Squibb Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001009","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004312","name":"Eli Lilly and Company","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004312","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004374","name":"Medtronic","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004374","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2015,11]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n \n Remnants are partially hydrolyzed, triglyceride\u2010rich lipoproteins that, like other apolipoprotein B\u2013containing lipoproteins, are atherogenic. Prior observational studies suggest paradoxically better outcomes in hypercholesterolemic patients who sustain an acute myocardial infarction (\n AMI<\/jats:styled-content>\n ), one of several known recurrent risk paradoxes. To date, the association of directly measured remnant lipoprotein cholesterol (\n RLP<\/jats:styled-content>\n \u2010C) with survival after an\n AMI<\/jats:styled-content>\n has not been examined.\n <\/jats:p>\n <\/jats:sec>\n \n Hypothesis<\/jats:title>\n \n Higher\n RLP<\/jats:styled-content>\n \u2010C levels may be paradoxically associated with lower mortality.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We examined 2465\n AMI<\/jats:styled-content>\n survivors in a prospective, 24\u2010center\n US<\/jats:styled-content>\n study of\n AMI<\/jats:styled-content>\n outcomes. Lipoprotein cholesterol subfractions were directly measured by ultracentrifugation. RLP\u2010C was defined as intermediate\u2010density lipoprotein cholesterol (\n IDL<\/jats:styled-content>\n \u2010C) + very\u2010low\u2010density lipoprotein cholesterol subfraction 3 (\n \n VLDL\n 3<\/jats:sub>\n <\/jats:styled-content>\n \u2010C). Given a linear relationship between\n RLP<\/jats:styled-content>\n \u2010C and mortality, we examined\n RLP<\/jats:styled-content>\n \u2010C by tertiles and continuously. Cox regression hazard ratios (\n HRs<\/jats:styled-content>\n ) were adjusted for the Global Registry of Acute Coronary Events (\n GRACE<\/jats:styled-content>\n ) score and 23 other covariates.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Participants were age 58 \u00b1 12 years (mean \u00b1\n SD<\/jats:styled-content>\n ), and 68% were men. After 2 years of follow\u2010up, 226 (9%) participants died. The mortality proportion was 12.4% in the lowest tertile of\n RLP<\/jats:styled-content>\n \u2010C (0\u201315 mg\/\n dL<\/jats:styled-content>\n ), 8.5% in the middle tertile (16\u201323 mg\/\n dL<\/jats:styled-content>\n ), and 6.8% in the highest tertile (24\u2013120 mg\/\n dL<\/jats:styled-content>\n ;\n P<\/jats:italic>\n < 0.001). A 1\u2010\n SD<\/jats:styled-content>\n increase in\n RLP<\/jats:styled-content>\n \u2010C (11 mg\/\n dL<\/jats:styled-content>\n ) predicted a 24% lower adjusted risk of 2\u2010year mortality (\n HR<\/jats:styled-content>\n : 0.76, 95% confidence interval [\n CI<\/jats:styled-content>\n ]: 0.64\u20100.91). Similar results were found for a 1\u2010\n SD<\/jats:styled-content>\n increase in\n IDL<\/jats:styled-content>\n \u2010C (\n HR<\/jats:styled-content>\n per 8 mg\/\n dL<\/jats:styled-content>\n : 0.80, 95%\n CI<\/jats:styled-content>\n : 0.67\u20100.96),\n \n VLDL\n 3<\/jats:sub>\n <\/jats:styled-content>\n \u2010C (\n HR<\/jats:styled-content>\n per 4 mg\/\n dL<\/jats:styled-content>\n : 0.74, 95%\n CI<\/jats:styled-content>\n : 0.61\u20100.89), and very\u2010low\u2010density lipoprotein cholesterol (\n VLDL<\/jats:styled-content>\n \u2010C;\n HR<\/jats:styled-content>\n per 8 mg\/\n dL<\/jats:styled-content>\n : 0.69, 95%\n CI<\/jats:styled-content>\n : 0.55\u20100.85).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Higher\n RLP<\/jats:styled-content>\n \u2010C levels were associated with lower mortality 2 years after\n AMI<\/jats:styled-content>\n despite rigorous adjustment for known confounders. Unknown protective factors or a lead\u2010time bias likely explains the paradox.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/clc.22470","type":"journal-article","created":{"date-parts":[[2015,10,13]],"date-time":"2015-10-13T13:53:17Z","timestamp":1444744397000},"page":"660-667","source":"Crossref","is-referenced-by-count":21,"title":["Remnant Lipoprotein Cholesterol and Mortality After Acute Myocardial Infarction: Further Evidence for a Hypercholesterolemia Paradox From the TRIUMPH Registry"],"prefix":"10.1002","volume":"38","author":[{"given":"Seth S.","family":"Martin","sequence":"first","affiliation":[{"name":"Johns Hopkins Ciccarone Center for the Prevention of Heart Disease Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamil F.","family":"Faridi","sequence":"additional","affiliation":[{"name":"Johns Hopkins Ciccarone Center for the Prevention of Heart Disease Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parag H.","family":"Joshi","sequence":"additional","affiliation":[{"name":"Johns Hopkins Ciccarone Center for the Prevention of Heart Disease Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Blaha","sequence":"additional","affiliation":[{"name":"Johns Hopkins Ciccarone Center for the Prevention of Heart Disease Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishnaji R.","family":"Kulkarni","sequence":"additional","affiliation":[{"name":"Atherotech Diagnostics Laboratory Birmingham Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arif A.","family":"Khokhar","sequence":"additional","affiliation":[{"name":"Northwest London Hospitals NHS Trust London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas M.","family":"Maddox","sequence":"additional","affiliation":[{"name":"VA Eastern Colorado Health Care System Denver Colorado"},{"name":"University of Colorado School of Medicine Aurora Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward P.","family":"Havranek","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine Aurora Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter P.","family":"Toth","sequence":"additional","affiliation":[{"name":"Johns Hopkins Ciccarone Center for the Prevention of Heart Disease Baltimore Maryland"},{"name":"Department of Preventive Cardiology CGH Medical Center Sterling Illinois"},{"name":"University of Illinois School of Medicine Peoria Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fengming","family":"Tang","sequence":"additional","affiliation":[{"name":"Saint Luke's Mid America Heart Institute University of Missouri\u2013Kansas City Kansas City Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A.","family":"Spertus","sequence":"additional","affiliation":[{"name":"Saint Luke's Mid America Heart Institute University of Missouri\u2013Kansas City Kansas City Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven R.","family":"Jones","sequence":"additional","affiliation":[{"name":"Johns Hopkins Ciccarone Center for the Prevention of Heart Disease Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,10,13]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000441139.02102.80"},{"key":"e_1_2_6_3_1","volume-title":"Global Status Report on Noncommunicable Diseases, 2010","author":"Alwan A","year":"2011"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000437738.63853.7a"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.005954"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000125278.58527.F3"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/ATVBAHA.107.157123"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11883-005-0037-x"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.5551\/jat.12.73"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2008.05.024"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.08.1026"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/clc.20518"},{"key":"e_1_2_6_13_1","doi-asserted-by":"crossref","first-page":"2557","DOI":"10.1161\/01.CIR.101.22.2557","article-title":"Predictors of outcome in patients with acute coronary syndromes without persistent ST\u2010segment elevation: results from an international trial of 9461 patients","volume":"101","author":"Boersma E","year":"2000","journal-title":"Circulation"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.163.19.2345"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-140-11-200406010-00006"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2014.12.006"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0000000000000131"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.163"},{"key":"e_1_2_6_19_1","first-page":"A3458","article-title":"Index event bias: why causal factors appear not to apply to disease recurrence [in Dutch]","volume":"155","author":"Smulders YM","year":"2011","journal-title":"Ned Tijdschr Geneeskd."},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2012.06.023"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.110.960468"},{"key":"e_1_2_6_22_1","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/S0022-2275(20)40123-3","article-title":"Quantification of cholesterol in all lipoprotein classes by the VAP\u2010II method","volume":"35","author":"Kulkarni KR","year":"1994","journal-title":"J Lipid Res."},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cll.2006.07.004"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.291.22.2727"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2010.06.009"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2003.09.074"}],"container-title":["Clinical Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fclc.22470","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/clc.22470","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,3]],"date-time":"2023-10-03T01:35:53Z","timestamp":1696296953000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/clc.22470"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,10,13]]},"references-count":25,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2015,11]]}},"alternative-id":["10.1002\/clc.22470"],"URL":"https:\/\/doi.org\/10.1002\/clc.22470","archive":["Portico"],"relation":{},"ISSN":["0160-9289","1932-8737"],"issn-type":[{"value":"0160-9289","type":"print"},{"value":"1932-8737","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,10,13]]}}}