Remnant Cholesterol - A Precise Atherosclerotic Cardiovascular Disease (ASCVD) Risk Indicator
A study published in the November, 2025 European Heart Journal found Remnant Cholesterol is a more precise risk indicator than LDL-C or ApoB for Atherosclerotic Cardiovascular Disease (ASCVD), the buildup of plaque in the arteries that can lead to heart disease and stroke. And it can be easily calculated from a standard lipid panel measures.
To calculate from a standard panel:
Total Cholesterol − LDL-Cholesterol − HDL-Cholesterol = Remnant Cholesterol (RC)
The result is the measure of triglyceride-rich lipoproteins, your remnant cholesterol.
Ideal RC: <20 mg/dL (<0.5 mmol/L)
If your triglycerides are consistently ≤90 mg/dL (ideally ≤70–80 mg/dL) on a fasting panel, your RC will almost always fall in the ideal ≤20 mg/dL zone automatically because RC is tightly linked to triglyceride levels.
Triglycerides rise primarily from excess refined carbohydrates, sugars, alcohol, weight gain (especially visceral fat), insulin resistance, menopause-related estrogen decline, certain medications, and underlying conditions like diabetes and hypothyroidism.
ASDVD Diagnostics Summary
For reference, below is an inventory of ASCVD diagnostics currently in use.
Marker | What It Measures | Strengths | When Used |
|---|---|---|---|
LDL-C | Cholesterol in LDL particles | Familiar, guideline-driven; direct causal link to ASCVD; easy to target with therapy. | Primary screening and treatment goal; still the benchmark for most patients. |
ApoB | Total number of atherogenic particles (LDL, VLDL, Lp(a), remnants). | Superior predictor of MI/ASCVD events; better in statin-treated or high-TG patients. | Discordant cases (normal LDL-C but high risk); recommended as secondary target in ESC/EAS. |
Remnant Cholesterol | Cholesterol in TG-rich remnants (calculated: total chol – LDL-C – HDL-C). | Stronger mortality predictor in CAD; highlights residual risk beyond ApoB. | Secondary prevention; optimal <20 mg/dL; ties to triglycerides as upstream driver. |
Lp(a) | Genetic risk factor (LDL-like particle). | Independent of LDL-C; now essential for family history screening. | All high-risk assessments; new ESC section on measurement. |
Non-HDL-C | All non-HDL cholesterol (LDL + remnants). | Simple calculation; better than LDL-C in hypertriglyceridemia. | When TG >200 mg/dL; secondary target in NLA/ADA. |