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The Forgotten Lipids: Triglycerides, Remnant Cholesterol, and Atherosclerotic Cardiovascular Disease Risk

Pratik B Sandesara1, Salim S Virani2,3, Sergio Fazio4

  • 1Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.

Endocrine Reviews
|October 13, 2018
PubMed

Insights

Atherosclerotic cardiovascular disease (ASCVD) is a major global killer. Elevated triglycerides (TGs) contribute to residual ASCVD risk, prompting research into novel TG-lowering therapies.

Area of Science:

  • Cardiology
  • Metabolic Disorders
  • Epidemiology

Background:

  • Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of global mortality.
  • Low-density lipoprotein cholesterol (LDL-C) reduction is key, but residual risk persists.
  • Hypertriglyceridemia, specifically remnant cholesterol (RC) from triglyceride-rich lipoproteins (TGRLs), is implicated in residual ASCVD risk.

Purpose of the Study:

  • To review the biological, epidemiological, and genetic links between triglycerides (TGs) and ASCVD.
  • To discuss current and emerging therapies for managing hypertriglyceridemia and reducing residual ASCVD risk.

Main Methods:

  • Comprehensive literature review of biological mechanisms, epidemiological data, and genetic studies.
  • Analysis of current and investigational therapeutic strategies for lowering TGs.

Main Results:

  • Strong evidence supports a causal role for TGs and RC in ASCVD development.
  • Lifestyle modifications are foundational, but novel TG-lowering drugs show significant efficacy.
  • Ongoing trials are evaluating the impact of new agents on ASCVD outcomes.

Conclusions:

  • Hypertriglyceridemia represents a significant, modifiable target for ASCVD prevention.
  • Novel pharmacological interventions hold promise for addressing residual risk in patients with elevated TGs.
  • Further research and clinical trials are crucial to establish the role of new TG-lowering therapies in ASCVD outcome reduction.

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