Elevated apolipoprotein B (apoB) due to high remnant cholesterol confers high risk of atherosclerotic cardiovascular disease (ASCVD) without prompting sufficient lipid-lowering therapy: a guideline-based limitation and an unmet medical need
Authors' conclusion
In a primary prevention setting, elevated apoB due to high remnant cholesterol confers high risk of ASCVD but less initiation of lipid-lowering therapy compared to elevated apoB due to high LDL cholesterol, representing a guideline-based limitation and an unmet medical need.
Study context
- Population
- Lipid-lowering therapy naïve adults without a history of ASCVD, Copenhagen General Population Study, 2003–20159,269 developed ASCVD
- Participants
- 94,299 adults
- Exposure
- Elevated apoB due to high remnant cholesterol vs elevated apoB due to high LDL-C, each vs concordant low values
- Outcome
- Incident ASCVD and initiation of lipid-lowering therapy
- Follow-up
- Median 12 years
Methodological detailsgeneral population cohort, discordance analysis
- General population cohort
- Discordance analysis
Main finding
As reported in the abstract
Estimate
High remnant cholesterol and high apoB, low LDL-C vs Concordant lowASCVD
HR 1.45(95% CI 1.34–1.56)
High remnant cholesterol and high apoB, low LDL-C vs Concordant lowstarting lipid-lowering therapy within one year
OR 3.0(CI 2.5–3.6)
Low remnant cholesterol, high apoB and high LDL-C vs Concordant lowASCVD
HR 1.20(CI 1.11–1.30)
Low remnant cholesterol, high apoB and high LDL-C vs Concordant lowstarting lipid-lowering therapy
OR 5.1(CI 4.3–5.9)
Observational data: associations, not effects.
Original publication
Elevated apoB due to high remnant cholesterol confers high risk of ASCVD without prompting sufficient lipid-lowering therapy: a guideline-based limitation and an unmet medical need. Eur J Prev Cardiol. Published 5 December 2025. doi:10.
Summarised from the published abstract; every number is checked against it