Remnant cholesterol continues to attract attention as a target to reduce residual cardiovascular risk. Conventionally, remnant cholesterol is defined as the cholesterol contained in remnant lipoprotein particles, i.e. metabolized very-low-density lipoprotein and intermediate-density lipoprotein in the fasting state, to which is added the cholesterol in chylomicron remnants in the postprandial. There is strong evidence from mechanistic, observational and genetic studies to support a causal association between remnant cholesterol and risk for atherosclerotic cardiovascular disease (ASCVD).
This month’s Landmark study adds to this evidence. In a Mendelian randomization study in over 900,000 subjects, each 1 standard deviation increase in remnant cholesterol increased the risk of myocardial infarction by more than 50%, independent of low-density lipoprotein cholesterol.