For a study, researchers came up with the idea that reclassifying people who subsequently suffer from myocardial infarction and ischemic heart disease would be reasonable, given the inclusion of high residual cholesterol.

They monitored 41,928 white Danish people from the Copenhagen General Population Study for more than ten years who had no prior history of ischemic cardiovascular disease, diabetes, or statin usage. They calculated the net reclassification index (NRI) from below to above 5%, 7.5%, and/or 10%. About 10-year occurrence of myocardial infarction and ischemic heart disease, defined as a composite of death from ischemic heart disease, myocardial infarction, and coronary revascularization using predefined cut-points for elevated remnant cholesterol. 

When remnant cholesterol levels were added to models based on conventional risk factors, no events were incorrectly reclassified for individuals with remnant cholesterol levels below the ≥95th percentile (≥1.6 mmol/L, 61 mg/dL), but 23% (P<0.001) of myocardial infarction and 21% (P<0.001) of ischemic heart disease were. As a result, the inclusion of residual cholesterol levels produced NRIs of 10% (95% CI: 1%-20%) for myocardial infarction and 5% (95% CI: -3% to13%) for ischemic heart disease. Likewise, when reclassifications from below to above 5%, 7.5%, and 10% risk of events were combined, 42% (P<0.001) of people with myocardial infarction and 41% (P<0.001) with ischemic heart disease were correctly reclassified, resulting in NRI of 20% (95% CI: 9% -31%) and 11%, respectively (95% CI: 2% -21%).

Increased residual cholesterol levels significantly enhance the ability to predict myocardial infarction and ischemic heart disease risk.