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Remnant Cholesterol and Residual Risk of Atherosclerotic Cardiovascular Disease

Xi Li1, Zhi-Fan Li1, Na-Qiong Wu1

  • 1Cardiometabolic Center, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, 100037 Beijing, China.

Reviews in Cardiovascular Medicine
|March 3, 2025
PubMed

Insights

Remnant cholesterol (RC) is a key target for atherosclerotic cardiovascular disease (ASCVD) residual risk. New therapies targeting RC show promise in reducing major adverse cardiovascular events (MACEs).

Area of Science:

  • Cardiology
  • Metabolic Research
  • Pharmacology

Background:

  • Remnant cholesterol (RC) is crucial for managing atherosclerotic cardiovascular disease (ASCVD) residual risk.
  • Current integration of RC into clinical practice faces challenges in measurement, treatment, and risk stratification.
  • Understanding RC's role in ASCVD development and its association with residual risk is vital.

Purpose of the Study:

  • To explore the complex role of remnant cholesterol (RC) in atherosclerotic cardiovascular disease (ASCVD) development.
  • To examine the impact of current lipid-lowering therapies on RC levels and cardiovascular outcomes.
  • To review advancements in targeted RC-lowering therapies and their potential to reduce major adverse cardiovascular events (MACEs).

Main Methods:

  • Review of existing literature on remnant cholesterol (RC) metabolism and its link to ASCVD.
  • Analysis of the effects of current lipid-lowering therapies on RC levels.
  • Evaluation of emerging therapies targeting RC, including ANGPTL3, apoCIII, and PCSK9 inhibitors.

Main Results:

  • Remnant cholesterol (RC) contributes significantly to residual cardiovascular risk.
  • Novel therapies targeting ANGPTL3, apoCIII, and PCSK9 effectively modulate RC levels.
  • These targeted therapies demonstrate potential in reducing major adverse cardiovascular events (MACEs).

Conclusions:

  • Targeted therapies for remnant cholesterol (RC) offer a promising strategy for reducing ASCVD morbidity and mortality.
  • Further large-scale randomized controlled trials are necessary to confirm the role of RC and its targeted therapies in patient care.
  • Optimizing RC management is essential for addressing residual risk in ASCVD patients.

Keywords:
angiopoietin-like protein 3apolipoprotein C-IIIatherosclerotic cardiovascular diseaselipid-lowering drugsmajor adverse cardiovascular eventsproprotein convertase subtilisin/kexin type 9remnant cholesterol

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