AIMS: High remnant cholesterol has been increasingly recognized as an important risk factor for atherosclerotic cardiovascular disease (ASCVD). However, uncertainty remains regarding this association in old age. The aim of this study was to test the hypothesis that higher remnant cholesterol is associated with higher incidence of ASCVD in healthy women and men aged 70-100. METHODS: 90,875 women (57%) and men aged 20-100 and without ASCVD, diabetes, or lipid-lowering therapy at baseline were included in the Copenhagen General Population Study in 2003-2015. During a median follow-up of 12.8 years, 7,352 were diagnosed with ASCVD. Incidence rates and hazard ratios were calculated according to age and sex. RESULTS: The highest incidence rate of ASCVD was observed in individuals aged 70-100 with a remnant cholesterol level >
1.0 mmol/L (>
39 mg/dL) (23 per 1000 person-years
95% confidence interval [CI]: 21-25). Likewise, incidence rates of ASCVD per 1.0 mmol/L (39 mg/dL) higher remnant cholesterol were highest in individuals aged 70-100. Multivariable adjusted hazard ratio for 1.0 mmol/L (39 mg/dL) higher remnant cholesterol was 1.31 (95% CI: 1.20-1.44) in those aged 70-100, which was comparable to hazard ratios in younger age groups. Similar relationships were observed for women and men separately. CONCLUSION: Higher remnant cholesterol was associated with higher incidence of ASCVD in those aged 70-100. The present results suggest that while relative rates of ASCVD for high versus low remnant cholesterol do not increase with higher age, elevated remnant cholesterol contribute substantially to the absolute risk of ASCVD at age 70-100.