A significant presence in atherosclerotic cardiovascular disease: Remnant cholesterol: A review

Area of Science:

• Cardiology
• Metabolic Disorders
• Atherosclerosis Research

Background:

• Current treatments for atherosclerotic cardiovascular disease (ASCVD) focus on lowering low-density lipoprotein cholesterol (LDL-C).
• Residual cardiovascular risk persists in patients despite achieving target LDL-C levels and managing other risk factors like hypertension and diabetes.
• Emerging evidence highlights remnant cholesterol (RC) as a significant contributor to atherosclerosis, beyond triglycerides.

Purpose of the Study:

• To emphasize the role of remnant cholesterol (RC) as a critical marker for predicting ASCVD.
• To advocate for prioritizing RC assessment and intervention in high-risk ASCVD patients, particularly when LDL-C is controlled.
• To explore the potential long-term benefits of reducing RC levels through lipid-lowering therapies.

Main Methods:

• Review of epidemiological investigations and genetic studies on remnant cholesterol (RC).
• Analysis of the role of triglyceride-rich remnant lipoprotein particles and their cholesterol component (RC) in atherosclerosis.
• Evaluation of current clinical practices and controversies surrounding routine RC testing.

Main Results:

• Epidemiological and genetic studies confirm RC's significant role in predicting ASCVD incidence.
• RC is identified as a crucial factor in residual cardiovascular risk, independent of LDL-C levels.
• Evidence suggests that controlling RC may offer additional cardiovascular protection.

Conclusions:

• Remnant cholesterol (RC) is a vital predictor of ASCVD and should be a focus for intervention in high-risk individuals, especially when LDL-C is managed.
• Reducing RC levels with lipid-lowering drugs may provide substantial long-term benefits for patients with ASCVD.
• Further research is needed to establish routine RC testing and optimal treatment strategies for elevated RC levels.