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VLDL cholesterol and ASCVD risk: A population-based study.

Mie Balling1, Otto Grøn Roepstorff2, Thomas Alexander Gerds2

  • 1Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark (Drs Balling, Varbo, Langsted, Nordestgaard, and Afzal); The Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark (Drs Balling, Varbo, Langsted, Nordestgaard, and Afzal); Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (Dr Balling, Roepstorff, and Dr Gerds).

Journal of Clinical Lipidology
|January 30, 2026
PubMed
Summary

Lowering very low-density lipoprotein (VLDL) cholesterol significantly reduces the 10-year risk of atherosclerotic cardiovascular disease (ASCVD). This study quantifies the absolute risk reduction from directly measured remnant cholesterol lowering.

Keywords:
AtherosclerosisCholesterolEpidemiologyHumansLipoproteinsMyocardial infarctionStrokeTRL-CTriglyceride-rich lipoproteinsVLDL cholesterol

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Area of Science:

  • Cardiology
  • Metabolic Disorders
  • Preventive Medicine

Background:

  • High remnant cholesterol levels are linked to atherosclerotic cardiovascular disease (ASCVD).
  • Emerging drugs effectively reduce remnant cholesterol, but their impact on absolute ASCVD risk needs clarification.
  • Direct measurement of remnant cholesterol is less studied than calculated values.

Purpose of the Study:

  • To estimate 10-year absolute risk reductions of ASCVD.
  • To analyze risk reduction based on proportional lowering of very low-density lipoprotein (VLDL) cholesterol.
  • Focus on individuals with VLDL cholesterol above 1 mmol/L.

Main Methods:

  • Utilized VLDL cholesterol directly measured by nuclear magnetic resonance spectroscopy.
  • Quantified remnant cholesterol using these direct measurements.
  • Estimated 10-year ASCVD risk reduction in a population subset (Copenhagen General Population Study) with elevated VLDL cholesterol, simulating proportional reductions.

Main Results:

  • A 50% proportional reduction in VLDL cholesterol correlated with a 3.0% absolute ASCVD risk reduction over 10 years.
  • An 80% proportional reduction in VLDL cholesterol was associated with a 4.5% absolute ASCVD risk reduction over 10 years.
  • Confidence intervals were 95% CI: 2.6%-3.4% for 50% reduction and 3.9%-5.1% for 80% reduction.

Conclusions:

  • Lowering VLDL cholesterol offers clinically significant benefits in primary ASCVD prevention.
  • Directly measured remnant cholesterol reduction is a viable therapeutic target.
  • The findings support interventions aimed at reducing VLDL cholesterol for cardiovascular health.