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This study evaluated arterial wall inflammation and bone marrow activity using 18F-FDG PET/CT (18F- fluoro-2-deoxy-d-glucose positron emission tomography–computed tomography) and monocyte phenotype with flow cytometry in 17 patients with familial dysbetalipoproteinaemia (characterized by increased total cholesterol and triglyceride levels) and 17 matched controls. Compared with controls, there was a 20% increase in 18F-FDG uptake in the arterial wall, as well as increased lipid accumulation and higher expression of surface integrins (CD11b, CD11c, and CD18) in patients with familial dysbetalipoproteinaemia. In addition, data from the Copenhagen General Population Study validated the correlation between remnant levels and hematopoietic activity, as well as the strong correlation with leukocyte counts. These findings support an important inflammatory component to the atherogenicity of remnant cholesterol, contributing to the increased cardiovascular disease risk in these patients.