Aim To evaluate whether remnant cholesterol combined with traditional blood lipid parameters can improve the predictive efficacy for major adverse cardiovascular and cerebrovascular events (MACCE) in prehypertensive patients. Methods The clinical data of 421 prehypertensive patients who underwent coronary angiography for coronary heart disease or suspected coronary heart disease in General Hospital of Northern Theater Command from 2004 to 2014 were retrospectively analyzed, and various types of data before coronary angiography were recorded during hospitalization, including basic clinical baseline data such as age, gender, height, weight, blood lipids, and blood glucose. A total of 95 patients were included in the case group when they were readmitted due to MACCE during long-term follow-up (follow-up methods included but not limited to telephone, SMS, etc.); 200 patients with prehypertension but without MACCE in the concurrent cohort were selected as the control group. The differences in clinical baseline data between the two groups were analyzed and compared, multivariate Logistic regression analysis was performed for various lipid parameters to determine their OR, receiver operating characteristic (ROC) curves were used to analyze the predictive value of various lipid parameters and combined predictors for MACCE in prehypertensive patients, and MEDCALC software was used to compare the area under the curve of traditional lipid parameters and combined predictors. Results The levels of remnant cholesterol, low density lipoprotein cholesterol (LDLC), triglyceride (TG), total cholesterol (TC), non-high density lipoprotein cholesterol (non-HDLC), remnant cholesterol/HDLC, and LDLC/HDLC in the case group were significantly higher than those in the control group, and the number of patients with high-salt diet and diabetes in the case group were also higher than those in the control group, and the above differences were statistically significant (P＜0.05). The results of multivariate Logistic regression analysis showed that remnant cholesterol, non-HDLC, TG, TC, remnant cholesterol/HDLC, and LDLC/HDLC were all independent predictors of prehypertension patients after adjusting for gender and age factors (P＜0.01). ROC curve analysis showed that the AUC of remnant cholesterol combined with other lipid parameters in predicting the occurrence of MACCE in prehypertensive patients was 0.704, while the AUC of remnant cholesterol or other lipid parameters in predicting the occurrence of MACCE in prehypertensive patients was less than that of the combined predictor; comparison of the AUC of the combined predictor with the AUC of lipid parameters alone using the DELONG method revealed significant differences in other AUC except for non-HDLC (P＝0.054), which showed borderline positivity (P＜0.05). Conclusions In prehypertensive patients, remnant cholesterol, LDLC, non-HDLC, TG, TC remnant cholesterol/HD-C, and LDLC/HDLC are independent risk factors for MACCE in such patients. The combined predictive value constructed by remnant cholesterol combined with other lipid parameters has a better predictive value for MACCE in prehypertensive patients.