Is ‘remnant cholesterol' the new culprit in heart disease?
Remnant cholesterol is being sold as the next breakthrough in heart disease — but our analysis of clinical trial evidence tells a different story.
Recently, I wrote about why the lipid hypothesis won’t die — how the cholesterol story keeps evolving, not by confronting uncertainty, but by shifting the goalposts.
It began with total cholesterol. Then LDL. Then came subfractions, ApoB and Lp(a) — and now, another contender has entered the frame: remnant cholesterol.
Each shift comes with the same promise that this is the missing piece, the explanation for the risk we still can’t account for.
Yet after decades of treatment with cholesterol-lowering drugs, cardiovascular events remain common, even when LDL is low — what’s often described as “residual risk.”
Remnant cholesterol is now being positioned as the explanation for that gap. Some have gone further, promoting it as the next major treatment target.
But our new study suggests it’s time to pause.
When you look at the evidence — not modelling or genetic analyses, but clinical trials where people take drugs and outcomes are measured — the story looks very different.