Triglyceride-Rich Lipoproteins, Remnants, and Atherosclerotic Cardiovascular Disease Risk

Purpose of Review To describe seminal studies and recent reports that have focused on the metabolism and quantification of triglyceride-rich lipoproteins (TRL) and remnants. Their role in atherosclerosis pathophysiology and association with cardiovascular risk along with therapeutic approaches is also discussed. Recent Findings TRL and remnants are produced by the metabolism of liver-derived very low-density lipoproteins and intestine-derived chylomicrons. They play an important role in atherosclerosis initiation and progression that is independent of low-density lipoprotein particles. Individuals with hypertriglyceridemia have elevated TRL concentration, but direct quantification is challenging. Large-scale epidemiologic studies have demonstrated the independent association of triglycerides, TRL, and remnants with cardiovascular risk. Fibrates and omega-3 fatty acids are commonly used to lower triglycerides and TRL in clinical practice. Volanesorsen is a novel antisense oligonucleotide that lowers triglycerides and TRL by targeting apolipoprotein C-III that has shown promising results in early-stage clinical testing. Summary TRL and remnants have an independent and likely causal relationship with atherosclerotic cardiovascular disease. Widespread quantification in clinical practice remains challenging, but emerging targeted therapies herald an exciting future for cardiovascular disease prevention.