Low-density lipoprotein cholesterol (LDL-C) remains the primary lipid target for cardiovascular prevention; however, its predictive value may be limited in chronic kidney disease (CKD), where atherogenic lipoprotein profiles are often complex. This analysis published in Atherosclerosis included 27,978 patients with CKD from the Kailuan cohort with a median follow-up of 13.81 years. 

Associations between LDL-C, remnant cholesterol (RC), and non-high-density lipoprotein cholesterol (non-HDL-C) with incident atherosclerotic cardiovascular disease (ASCVD) were assessed using Cox proportional hazards models and restricted cubic spline analyses. Discordance analyses applied clinically relevant lipid cutoffs.

Higher LDL-C, non-HDL-C, and RC levels were each associated with increased ASCVD risk. However, associations for non-HDL-C and RC were more consistent across subgroups, whereas

LDL-C associations were more heterogeneous. In discordance analyses, participants with elevated non-HDL-C or RC but normal LDL-C had significantly higher ASCVD risk compared with those with concordantly low lipid levels.

These findings suggest that non-HDL-C and RC may provide complementary risk information in CKD beyond LDL-C alone.