Heart health

Remnant cholesterol

RC, remnant-C

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A closer look at cholesterol in triglyceride-rich particles.

Remnant cholesterol is calculated by subtracting your LDL and HDL cholesterol from your total cholesterol. It estimates the cholesterol carried in triglyceride-rich particles, which research increasingly links with heart disease.

This number is closely tied to your triglycerides.

Your liver and gut package fat into triglyceride-rich particles. As these particles release their triglycerides, the smaller particles left behind, called remnants, still carry cholesterol and can enter artery walls.

Many labs calculate LDL cholesterol from your triglycerides using the Friedewald equation. When they do, remnant cholesterol works out to your triglycerides divided by 2.2, so it adds little beyond your triglyceride result. Research on remnant cholesterol is growing, and Canadian guidelines don't use it as a treatment target.

Remnant cholesterol and triglycerides tell a closely related story.

Questions

What does a higher result mean?

A higher result usually goes with higher triglycerides, and studies link it with a higher risk of heart attack. A clinician reads it with your LDL cholesterol, ApoB, HbA1c, and other risk factors.

Does eating before the test change it?

It can. Triglycerides rise for several hours after a meal, and calculated remnant cholesterol rises with them. Let your clinician know when you last ate if your result is higher than expected.

Does lowering remnant cholesterol lower heart risk?

That isn't settled yet. In one large trial, a drug that lowered triglycerides and remnant cholesterol without lowering LDL cholesterol didn't reduce cardiovascular events. For now, clinicians focus on your overall risk and on LDL cholesterol, non-HDL cholesterol, or ApoB.

Sources and references