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Published on: November 10, 2017

Lipid-related cardiovascular risk beyond low-density lipoprotein cholesterol

Mie Balling1,2,3, Karen Hvid4,2,5, Anette Varbo4,2

  • 1Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark mie.balling@sund.ku.dk.

Heart (British Cardiac Society)
|May 14, 2026
PubMed

Insights

This review highlights lipid risks for atherosclerotic cardiovascular disease (ASCVD) beyond LDL cholesterol. Emerging evidence supports targeting remnant particles and lipoprotein(a) for better ASCVD prevention, especially with rising obesity rates.

Area of Science:

  • Cardiology
  • Metabolic Syndrome
  • Lipidology

Background:

  • High LDL cholesterol is a primary driver of atherosclerotic cardiovascular disease (ASCVD).
  • Decades of research focused on lowering LDL cholesterol levels.
  • Increasing global rates of obesity, insulin resistance, diabetes, and metabolic syndrome necessitate broader risk assessment.

Purpose of the Study:

  • To provide an overview of lipid-related ASCVD risks beyond LDL cholesterol.
  • To discuss the role of remnant particles and lipoprotein(a) in ASCVD.
  • To emphasize the growing importance of targeting metabolic dysregulation and genetic lipid drivers of ASCVD.

Main Methods:

  • Review of interventional, mechanistic, observational, and genetic studies.
  • Analysis of evidence supporting causal roles of remnant particles and lipoprotein(a).
  • Discussion of emerging therapeutic strategies targeting these lipoproteins.

Main Results:

  • Elevated remnant particles and high lipoprotein(a) are causally linked to ASCVD development.
  • Lipoprotein(a) levels are genetically determined.
  • Remnant cholesterol levels strongly correlate with overeating, obesity, and diabetes.

Conclusions:

  • Focus is shifting beyond LDL cholesterol to additional ASCVD risk measures.
  • New drugs targeting remnant particles and lipoprotein(a) are under development.
  • Targeting lipids involved in metabolic dysregulation and genetic drivers is crucial for future ASCVD prevention, particularly in the context of the obesity pandemic.

Keywords:
Cardiovascular DiseasesHyperlipidemiasPharmacologyRisk Factors

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