Key Takeaways
- Remnant cholesterol (RC) is the cholesterol content left in the blood after triglycerides are removed from VLDL and IDL particles.
- RC is a significant marker of lipid metabolism and is linked to an increased risk of cardiovascular disease.
- High-carbohydrate diets can elevate triglyceride levels, leading to higher RC levels and greater cardiovascular risk.
- A low-carbohydrate, high-fat diet focused on animal products can help lower triglyceride and RC levels, improving heart health.
- Regular exercise and managing metabolic health are essential for keeping RC levels low and reducing overall cardiovascular risk.
Introduction
Cholesterol plays a significant role in our health, affecting everything from cell function to hormone production.
Remnant cholesterol (RC) is a lesser-known type of cholesterol that’s important for understanding heart health and cardiovascular risk.
What is Remnant Cholesterol (RC)?
Definition of RC
Remnant cholesterol refers to the cholesterol found in remnants of lipoproteins, specifically those that remain after the body has processed triglyceride-rich particles.
Formation of RC
RC forms when your body breaks down particles like very-low-density lipoproteins (VLDL) and intermediate-density lipoproteins (IDL).
As these particles shed their triglycerides for energy, they leave behind cholesterol-rich remnants.
The Role of RC in the Body
RC serves as a marker for how your body processes lipids (fats). Elevated RC levels can signal issues with lipid metabolism and have been linked to an increased risk of heart disease.
Origins of Triglycerides Leading to RC
Dietary Sources of Triglycerides
Triglycerides come from the fats in the foods we eat. When you consume dietary fats, they are broken down into triglycerides, which enter the bloodstream and are used for energy or stored as fat.
Liver Synthesis of Triglycerides
The liver also produces triglycerides, especially when there is an excess intake of carbohydrates.
The liver converts these carbs into triglycerides, which are then packaged into VLDL particles.
Impact of Carbohydrate Restriction on RC
A diet low in carbohydrates and rich in animal products can lower triglyceride levels. This reduction leads to fewer remnant particles and, consequently, lower levels of RC.
RC and Cardiovascular Disease
Atherogenic Potential of RC
RC is considered atherogenic, meaning it can contribute to the formation of plaques in the arteries.
These plaques can lead to blockages, increasing the risk of heart attacks and strokes.
RC vs. LDL and HDL Cholesterol
While LDL (“bad”) cholesterol and HDL (“good”) cholesterol are often discussed, RC plays a unique role.
Unlike HDL, which helps remove cholesterol from the bloodstream, and LDL, which can deposit cholesterol in arteries, RC represents the leftover cholesterol that didn’t get used up or processed efficiently, posing its own risks.
Current Research on RC
Recent studies suggest that RC is a significant predictor of cardiovascular disease. People with high RC levels might be at risk even if their LDL levels are within normal ranges.
Factors Influencing RC Levels
Impact of High-Carbohydrate Diets
High-carbohydrate diets can lead to elevated triglyceride levels, which in turn increase RC.
This is because excess carbs are converted into triglycerides by the liver, contributing to the formation of remnant particles.
Benefits of a Low-Carbohydrate, High-Fat Diet
A low-carb, high-fat diet, especially one focused on nutrient-dense animal foods, can help lower triglycerides and, by extension, RC levels.
This type of diet encourages the body to use fats as a primary energy source, reducing the need to store or circulate excess triglycerides.
Role of Physical Activity and Metabolism
Regular physical activity boosts metabolism and helps your body process triglycerides more efficiently, which can lead to lower RC levels.
Exercise also improves overall cardiovascular health.
Managing RC Levels
Nutritional Strategies
To manage RC, focus on a diet rich in animal fats and proteins, and low in carbohydrates.
Foods like fatty fish, eggs, and red meat provide essential nutrients while helping to keep triglyceride and RC levels in check.
Monitoring and Testing for RC
Regular blood tests can help track RC levels along with other cholesterol markers. Knowing your RC levels can provide a more complete picture of your cardiovascular risk.
Potential Role of Supplements and Medications
Food supplements like cod liver oil can help lower triglycerides and RC.
In some cases, medications may also be recommended to manage RC and overall cholesterol levels.
Conclusion
Understanding remnant cholesterol is key to assessing and improving heart health. By focusing on diet and lifestyle changes, particularly those that emphasize animal-based nutrients and limit carbohydrates, you can manage RC levels and support long-term cardiovascular health.
FAQs
What is the difference between remnant cholesterol and LDL cholesterol?
Remnant cholesterol is the leftover cholesterol after triglycerides are removed from VLDL and IDL particles, while LDL cholesterol is primarily involved in transporting cholesterol to tissues.
How can I naturally lower my remnant cholesterol levels?
A diet low in carbohydrates and rich in healthy animal fats, combined with regular exercise, can help lower RC levels naturally.
Is remnant cholesterol a more accurate predictor of heart disease than traditional cholesterol measures?
RC is gaining recognition as an important predictor of cardiovascular risk, especially in combination with other cholesterol markers.
Does eating a high-fat, low-carbohydrate diet always reduce RC?
Yes, for many people, this type of diet can reduce triglyceride levels and subsequently lower RC.
What tests should I ask for to monitor my cholesterol health?
Ask for a full lipid panel that includes measurements of total cholesterol, LDL, HDL, triglycerides, and remnant cholesterol to get a comprehensive view of your heart health.
Research
Aberra, T., Peterson, E.D., Pagidipati, N.J., Mulder, H., Wojdyla, D.M., Philip, S., Granowitz, C., & Navar, A.M. (2020). The association between triglycerides and incident cardiovascular disease: What is “optimal”? *Journal of Clinical Lipidology*, 14(4), 438-447.e3. https://doi.org/10.1016/j.jacl.2020.04.009
Balling, M., Langsted, A., Afzal, S., Varbo, A., Davey Smith, G., & Nordestgaard, B.G. (2019). A third of nonfasting plasma cholesterol is in remnant lipoproteins: Lipoprotein subclass profiling in 9293 individuals. *Atherosclerosis*, 286, 97-104. https://doi.org/10.1016/j.atherosclerosis.2019.05.011
Bai, M., Liao, J., Wang, Y., Liang, M., Wang, C., Zhang, J., & Shao, M. (2024). Remnant cholesterol and all-cause mortality risk: Findings from the National Health and Nutrition Examination Survey, 2003-2015. *Front Endocrinol (Lausanne)*, 15, 1417228. https://doi.org/10.3389/fendo.2024.1417228
Elshazly, M.B., Mani, P., Nissen, S., Brennan, D.M., Clark, D., Martin, S., Jones, S.R., Quispe, R., Donnellan, E., Nicholls, S.J., & Puri, R. (2020). Remnant cholesterol, coronary atheroma progression and clinical events in statin-treated patients with coronary artery disease. *European Journal of Preventive Cardiology*, 27(10), 1091-1100. https://doi.org/10.1177/2047487319887578
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Joshi, P.H., Khokhar, A.A., Massaro, J.M., Lirette, S.T., Griswold, M.E., Martin, S.S., Blaha, M.J., Kulkarni, K.R., Correa, A., D'Agostino, R.B. Sr., Jones, S.R., & Toth, P.P.; Lipoprotein Investigators Collaborative (LIC) Study Group. (2016). Remnant lipoprotein cholesterol and incident coronary heart disease: The Jackson Heart and Framingham Offspring Cohort Studies. *Journal of the American Heart Association*, 5(5), e002765. https://doi.org/10.1161/JAHA.115.002765
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Kaltoft, M., Langsted, A., & Nordestgaard, B.G. (2020). Triglycerides and remnant cholesterol associated with risk of aortic valve stenosis: Mendelian randomization in the Copenhagen General Population Study. *European Heart Journal*, 41(24), 2288-2299. https://doi.org/10.1093/eurheartj/ehaa172
Karpe, F., Boquist, S., Tang, R., Bond, G.M., de Faire, U., & Hamsten, A. (2001). Remnant lipoproteins are related to intima-media thickness of the carotid artery independently of LDL cholesterol and plasma triglycerides. *Journal of Lipid Research*, 42(1), 17–21. https://doi.org/10.1016/s0022-2275(20)32331-2
Kim, Y., Park, H., Jeong, W., Schellingerhout, D., Park, E., Lee, D. K., Choi, W. J., Chae, L., & Kim, E. (2011). High Levels of Remnant Lipoprotein Cholesterol Is a Risk Factor for Large Artery Atherosclerotic Stroke. Journal of Clinical Neurology (Seoul, Korea), 7(4), 203-209.
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Li, Z., Zhang, B., Salaun, E., Côté, N., Mahjoub, H., Mathieu, P., Dahou, A., Zenses, A.S., Xu, Y., Pibarot, P., Wu, Y., & Clavel, M.A. (2023). Association between remnant cholesterol and progression of bioprosthetic valve degeneration. *European Heart Journal - Cardiovascular Imaging*, 24(12), 1690-1699. https://doi.org/10.1093/ehjci/jead159
Li, Z.H., Hao, Q.Y., Zeng, Y.H., Guo, J.B., Li, S.C., Gao, J.W., Yang, P.Z. (2024). Remnant cholesterol and the risk of aortic valve calcium progression: Insights from the MESA study. *Cardiovascular Diabetology*, 23(1), 20. https://doi.org/10.1186/s12933-023-02081-2
Maggi, F.M., Raselli, S., Grigore, L., Redaelli, L., & Catapano, A.L. (2004). Lipoprotein remnants and endothelial dysfunction in the postprandial phase. *The Journal of Clinical Endocrinology & Metabolism*, 89(6), 2946-2950. https://doi.org/10.1210/jc.2003-031977
McNamara, J.R., Shah, P.K., Nakajima, K., Cupples, L.A., Wilson, P.W., Ordovas, J.M., & Schaefer, E.J. (1998). Remnant lipoprotein cholesterol and triglyceride reference ranges from the Framingham Heart Study. *Clinical Chemistry*, 44(6 Pt 1), 1224-1232. https://doi.org/10.1093/eurheartj/ehs431
Miller M, Stone NJ, Ballantyne C, Bittner V, Criqui MH, Ginsberg HN, Goldberg AC, Howard WJ, Jacobson MS, Kris-Etherton PM, Lennie TA, Levi M, Mazzone T, Pennathur S; American Heart Association Clinical Lipidology, Thrombosis, and Prevention Committee of the Council on Nutrition, Physical Activity, and Metabolism; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular Nursing; Council on the Kidney in Cardiovascular Disease. Triglycerides and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2011 May 24;123(20):2292-333. doi: 10.1161/CIR.0b013e3182160726. Epub 2011 Apr 18. PMID: 21502576.
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Pirillo, A., Norata, G.D., & Catapano, A.L. (2020). Beyond LDL-C levels, does remnant cholesterol estimation matter? *European Journal of Preventive Cardiology*, 27(10), 1088-1090. https://doi.org/10.1177/2047487319899622
Quispe, R., Martin, S. S., Michos, E. D., Lamba, I., Blumenthal, R. S., Saeed, A., Lima, J., Puri, R., Nomura, S., Tsai, M., Wilkins, J., Ballantyne, C. M., Nicholls, S., Jones, S. R., & Elshazly, M. B. (2021). Remnant cholesterol predicts cardiovascular disease beyond LDL and ApoB: A primary prevention study. European Heart Journal, 42(42), 4324-4332.
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Varbo, A., Benn, M., Tybjærg-Hansen, A., Jørgensen, A.B., Frikke-Schmidt, R., & Nordestgaard, B.G. (2013). Remnant cholesterol as a causal risk factor for ischemic heart disease. *Journal of the American College of Cardiology*, 61(4), 427-436. https://doi.org/10.1016/j.jacc.2012.08.1026
Varbo, A., Benn, M., Tybjærg-Hansen, A., & Nordestgaard, B.G. (2013). Elevated remnant cholesterol causes both low-grade inflammation and ischemic heart disease, whereas elevated low-density lipoprotein cholesterol causes ischemic heart disease without inflammation. *Circulation*, 128(12), 1298-1309. https://doi.org/10.1161/CIRCULATIONAHA.113.003008
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