Remnant cholesterol, vascular risk, and prevention of atherosclerosis

Area of Science:

• Cardiovascular Medicine
• Lipid Metabolism
• Pharmacology

Background:

• Residual atherothrombotic cardiovascular disease (ACVD) risk persists despite optimal LDL-C control.
• Alterations in triglyceride-rich lipoproteins and remnant cholesterol are key contributors to this residual risk.
• Remnant cholesterol's atherogenic potential is linked to arterial wall infiltration and inflammatory responses.

Purpose of the Study:

• To highlight the role of remnant cholesterol in residual ACVD risk.
• To discuss the assessment of remnant cholesterol for risk stratification.
• To review therapeutic strategies for managing remnant cholesterol and hypertriglyceridemia.

Main Methods:

• Epidemiological studies, Mendelian randomization, and clinical trial analyses demonstrate remnant cholesterol's association with ACVD risk.
• Evaluation of remnant cholesterol alongside LDL-C, non-HDL-C, and apoB for risk assessment.
• Review of the REDUCE-IT study on icosapent ethyl for ACVD prevention.

Main Results:

• Remnant cholesterol is an independent predictor of ACVD risk, beyond LDL-C levels.
• Remnant triglyceride-rich lipoproteins are highly atherogenic.
• Icosapent ethyl showed efficacy in preventing ACVD in high-risk hypertriglyceridemic patients.

Conclusions:

• Assessing remnant cholesterol provides crucial information on residual ACVD risk, especially in specific patient groups.
• Effective management of remnant cholesterol and hypertriglyceridemia is vital for ACVD prevention.
• Emerging lipid-lowering therapies hold promise for defining treatment criteria for excess remnant cholesterol.