Remnant cholesterol, also known as remnant lipoprotein and triglyceride-rich lipoprotein cholesterol is an atherogenic lipoprotein composed primarily of very low-density lipoprotein (VLDL) and intermediate-density lipoprotein (IDL) with chylomicron remnants. [1] [2] [3] Elevated remnant cholesterol is associated with increased risk of atherosclerotic cardiovascular disease and stroke. [3] [4]
Remnant cholesterol is the cholesterol content of triglyceride-rich lipoproteins, which consist of very low-density lipoproteins and intermediate-density lipoproteins with chylomicron remnants. [2] [5] Remnant cholesterol is primarily chylomicron and VLDL, and each remnant particle contains about 40 times more cholesterol than LDL. [6]
Remnant cholesterol corresponds to all cholesterol not found in high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C). It is calculated as total cholesterol minus HDL-C and LDL-C. [7]
Elevated remnant cholesterol is associated with an increased risk of atherosclerotic cardiovascular disease, chronic inflammation, myocardial infarction and stroke. [4] [5] [8] [9] Remnant cholesterol is especially predictive of coronary artery disease in patients with normal total cholesterol. [10] [11]
High plasma remnant cholesterol is associated with increased plasma triglyceride levels. [12] Hypertriglyceridemia is characteristic of high plasma remnant cholesterol, but persons with high plasma triglycerides without high remnant cholesterol rarely have coronary artery disease. [13]
Remnant cholesterol has about twice the association with ischemic heart disease as LDL cholesterol. [14] Although remnant cholesterol tends to be higher in people who are overweight (high body mass index), normal-weight persons with high remnant cholesterol tend to have a higher risk of myocardial infarction. [15]
Vupanorsen, an ANGPTL3 inhibitor has been shown to lower remnant cholesterol up to 59%. [16]
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