Hypertriglyceridemia (> 150 mg/dL) as a marker of cardiovascular risk

In patients who have achieved optimal LDL-C control, there remains a residual risk of atherothrombotic cardiovascular disease (ASCVD) related to alterations in lipid metabolism, among which alterations in triglyceride-rich lipoproteins and the cholesterol they contain, known as remnant cholesterol, play a major role. Remnant cholesterol is related to ASCVD risk that is independent of LDL-C and has been demonstrated in epidemiological and Mendelian randomization studies. Numerous epidemiological and genetic Mendelian randomization studies support that elevated triglyceride-rich lipoproteins (TRL) and remnant cholesterol are causally associated with ASCVD, myocardial infarction, ischemic stroke, aortic valve stenosis, and all-cause mortality. The remnant particles of triglyceride-rich lipoproteins are highly atherogenic due to their ability to enter and be retained in the arterial wall, their high cholesterol content, and their capacity to generate foam cells, induce endothelial dysfunction, a prothrombotic environment, and a vascular inflammatory response. Assessment of remnant cholesterol can provide information about residual ASCVD risk beyond that provided by LDL-C, non-HDL-C, and apoB, particularly in individuals with hypertriglyceridemia, type 2 diabetes, or metabolic syndrome.