Medically Reviewed by Vincenta Faulkner, RD, CNSC, CCTD
A large portion — one-third, to be exact — of all deaths in our country result from heart disease, stroke, and cardiovascular disease. You might guess the main culprit: “bad” cholesterol, also known as LDL cholesterol. This cholesterol type poses a major threat to heart health because it deposits lipids on blood vessel walls, which causes build-up, hardened arteries, and blockages.
However, some patients with normal LDL cholesterol (LDL-C) levels still present with cardiovascular disease. This means an additional or increased risk of adverse cardiovascular events, despite LDL cholesterol-lowering; researchers call this risk “residual risk.”
Residual risk is present because other factors raise LDL-C levels, notedly: remnant cholesterol.
Doctors and researchers increasingly recognize remnant cholesterol as its own individual metric to identify potential threats for cardiovascular disease and disease potential when LDL levels cannot.
Let’s learn more about remnant cholesterol with Zizi.
What Is Remnant Cholesterol?
Different parts comprise non-HDL cholesterol, namely LDL cholesterol and remnant cholesterol. Remnant cholesterol (RC) is the cholesterol content for triglyceride-rich proteins.
More specifically, intermediate-density lipoproteins, very-low-density lipoproteins, and chylomicron remnants comprise remnant cholesterol.
Basically, it’s all the cholesterol carried by everything besides HDL and LDL.
A Causal Factor for Increased Cardiovascular Risk
Triglycerides and remnant cholesterol strongly correlate—when you lower triglyceride levels, you lower remnant cholesterol levels. Remnant cholesterol and triglycerides link to cardiovascular disease and increased cardiovascular risk in several different ways.
First, elevated RC levels directly correlate with cardiovascular disease and are strongly linked to increased cardiovascular risk. This is why remnant cholesterol helps hugely inform cardiovascular events and supplement LDL-C monitoring as a way to determine an individual’s risk factor for presenting with cardiovascular disease.
So how do triglycerides, and the cholesterol content within their triglyceride-heavy lipoproteins (RC), play an identifiable causal role in atherosclerotic cardiovascular disease onset (i.e. heart disease)?
They break through the artery walls and deposit in very tight quarters, a capability that makes them more mobile than triglycerides.
This is why researchers believe that remnant cholesterol, and not triglycerides, cause atherosclerosis; remnants are just small enough to pass through to the interior wall and result in plaque formation.
Most cells can degrade triglycerides, but not cholesterol; its buildup is hard to break down or reverse at all.
Remnant Cholesterol as Wholly Independent From LDL
Various studies indicate that high RC and triglyceride levels, but not high LDL-C levels, can cause adverse cardiovascular outcomes. These studies highlight how independent remnant cholesterol has emerged as a factor that influences cardiovascular problems without connecting to other risk factors like LDL-C.
One recent study, in particular, found that subjects with a measured RC level higher than 24 mg/dL of blood had a 40-50% higher risk for major heart disease or stroke; almost one in five of these people had major heart disease or stroke within the following 18 years even with relatively low LDL cholesterol levels.
It is also important to view remnant cholesterol and LDL cholesterol levels separately when analyzing risk for cardiovascular disease because they cause atherosclerosis differently.
Remnant cholesterol results in atherosclerosis with inflammation; on the contrary, atherosclerosis due to LDL cholesterol deposits do not result in inflammation.
This is because LDL requires modification before entering the arterial wall, and is also smaller, carrying less cholesterol per particle when compared to RC (which transports far more cholesterol per particle and requires modification before entering the arterial wall).
Researchers believe these differences make remnant cholesterol atherogenic (meaning they promote the build-up of that fatty plaque) with an additional inflammatory trait, yet LDL-C is also atherogenic but without the inflammation, and overall reinforces that the two cholesterol types are distinctly separate.
Interactions With Other Risk Factors
Several medical studies also highlight that remnant cholesterol interacts with other risk factors, such as age, biological sex, hypertension, diabetes, and smoking, to contribute to cardiovascular disease progression.
Some interactions are more clear-cut — people with higher remnant cholesterol levels were generally consistently more obese and diabetic, and almost always had high triglyceride levels.
However, how remnant cholesterol interacts with other risk factors in light of cardiovascular disease is not as clear-cut or well understood at the moment.
How Do I Calculate My Remnant Cholesterol?
You can, fortunately, discern your RC level pretty easily; all you need to do is get your routine lipid panel done.
With the data your standard lipid panel gives you, you can calculate your remnant cholesterol level by subtracting your low-density lipoprotein and high-density lipoprotein levels from your total cholesterol level.
In other words, you can calculate remnant cholesterol by subtracting your LDL-C from your non-HDL-C:
[ RC = non-HDL-C — LDL-C ]
Even though discerning your remnant cholesterol value from your total lipid panel requires a little math, it is just one simple calculation that can really bolster your risk analysis for cardiovascular disease. No algebra here, don’t worry.
What Causes Remnant Cholesterol?
There are various risk factors for remnant cholesterol, and gaining a better understanding of these factors may help you minimize your risk. You can separate the causes of remnant cholesterol (increased triglyceride levels) into primary and secondary factors.
Primary Risk Factors for Remnant Cholesterol
If genes that play a role in the clearance pathway for VLDL or chylomicron clearance mutate, severe high triglyceride levels may result because triglyceride clearance is either significantly reduced or absent altogether.
This form of gene mutation is the main primary risk factor for remnant cholesterol.
Secondary Risk Factors for Remnant Cholesterol
Secondary risk factors for remnant cholesterol include a carbohydrate-heavy or saturated-fat heavy diet, excessive alcohol intake, obesity, a sedentary lifestyle, hypothyroidism, chronic kidney disease, diabetes, medications, and pregnancy.
Secondary factors that result from unideal lifestyle habits, such as poor diet or sedentary lifestyle, will usually only moderately elevate your triglyceride levels.
Pregnancy is included as a risk factor because the third trimester marks a huge increase in the mother’s triglyceride levels in response to many hormone changes. Estrogen levels in this trimester markedly rise, which jumpstarts VLDL secretion and prevents much of our natural triglyceride clearance, meaning triglycerides can rise.
How Do I Lower My Remnant Cholesterol?
You can take on the same strategy for lowering your non-HDL cholesterol levels as you would for lowering your remnant cholesterol levels. This means that modifications to your lifestyle remain the primary way to effectively manage hypertriglyceridemia and RC at home.
If you are not active, increase the amount of exercise you get each week – even just a little more motion in your life can lower triglycerides and increase your good cholesterol! More frequent exercise can also get you on the path towards tackling weight loss goals, which also supports better cholesterol levels.
Another key lifestyle change you can try is to modify your diet. Rather than consuming foods with saturated and trans fats (red meats, rich dairy, sugary snacks, processed treats), focus on whole foods with more of the good, like vitamins and minerals (think fruits and veggies), and less of the bad, like bad fats and simple carbs like sugar.
Zizi: Monthly Heart Monitoring Without the Hoops
Your LDL cholesterol level is critical to your cardiac disease risk evaluation. However, you should also include remnant cholesterol when thinking about your cardiac health and risk for cardiac disease.
Even if you have normal LDL cholesterol levels, you may still have high, potentially harmful remnant cholesterol levels that can affect your heart health.
Zizi is here to help you every step of the way — we know some of this stuff can be complicated, and we hope to help simplify it so it’s easy to take care of your heart health.
With our Heart Health Reset Program, you have access to monthly cholesterol testing to monitor your levels. Our six-month subscription also provides you with additional resources, including our all-natural heart health supplements with FDA-approved claims, and our heart health course.
If you have high remnant cholesterol levels, Zizi is here to help you move towards treatment and prevention in the easiest way possible—without ever leaving your house.
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