PDF(Pubmed)
Abstract：
The current first-line treatment for atherosclerotic cardiovascular disease (ASCVD) involves the reduction of a patient\'s low-density lipoprotein cholesterol (LDL-C) levels through the use of lipid-lowering drugs. However, even when other risk factors such as hypertension and diabetes are effectively managed, there remains a residual cardiovascular risk in these patients despite achieving target LDL-C levels with statins and new lipid-lowering medications. This risk was previously believed to be associated with lipid components other than LDL, such as triglycerides. However, recent studies have unveiled the crucial role of remnant cholesterol (RC) in atherosclerosis, not just triglycerides. The metabolized product of triglyceride-rich lipoproteins is referred to as triglyceride-rich remnant lipoprotein particles, and its cholesterol component is known as RC. Numerous pieces of evidence from epidemiological investigations and genetic studies demonstrate that RC plays a significant role in predicting the incidence of ASCVD. As a novel marker for atherosclerosis prediction, when LDL-C is appropriately controlled, RC should be prioritized for attention and intervention among individuals at high risk of ASCVD. Therefore, reducing RC levels through the use of various lipid-lowering drugs may yield long-term benefits. Nevertheless, routine testing of RC in clinical practice remains controversial, necessitating further research on the treatment of elevated RC levels to evaluate the advantages of reducing RC in patients at high risk of ASCVD.
摘要：
目前动脉粥样硬化性心血管疾病（ASCVD）的一线治疗包括通过使用降脂药降低患者的低密度脂蛋白胆固醇（LDL-C）水平。然而,即使高血压和糖尿病等其他危险因素得到有效控制，尽管他汀类药物和新的降脂药物达到目标LDL-C水平,但这些患者仍存在残余的心血管风险.以前认为这种风险与LDL以外的脂质成分有关，如甘油三酯。然而,最近的研究揭示了残余胆固醇（RC）在动脉粥样硬化中的关键作用，不仅仅是甘油三酯.富含甘油三酯的脂蛋白的代谢产物被称为富含甘油三酯的残留脂蛋白颗粒，它的胆固醇成分被称为RC。来自流行病学调查和遗传研究的大量证据表明，RC在预测ASCVD的发病率中起着重要作用。作为一种新的动脉粥样硬化预测标志物，当LDL-C得到适当控制时，在ASCVD高危人群中，应优先注意和干预RC。因此,通过使用各种降脂药物降低RC水平可能会产生长期益处.然而，RC在临床实践中的常规测试仍然存在争议，需要对RC水平升高的治疗进行进一步研究，以评估降低ASCVD高危患者RC的优势。
