Remnant cholesterol

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 composed primarily of VLDL, IDL and chylomicron remnants

Definition

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]

Health effects

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]

Lowering remnant cholesterol

Vupanorsen, an ANGPTL3 inhibitor has been shown to lower remnant cholesterol up to 59%.^[16]

See also

• Chylomicron remnant
• Lipid profile