Swedish researchers point to TRL and Lp(a) as residual heart disease risk beyond LDL

Researchers at Chalmers University of Technology in Sweden used proteomics to study how three fat-carrying particles - LDL, triglyceride-rich lipoproteins (TRL) and lipoprotein(a), or Lp(a) - affect blood vessels and contribute to coronary heart disease, according to a release. The work focuses on why some people still develop heart disease after LDL cholesterol, the bad cholesterol targeted by treatment, is lowered to recommended levels. The study examines biology beyond cholesterol buildup.

The release says the team analyzed biological changes associated with lipoprotein particles rather than measuring only cholesterol carried by LDL. It points to TRL and Lp(a) as major contributors to residual cardiovascular risk after LDL is controlled. In an earlier study by the same group, counting harmful lipoprotein particles was described as the most effective predictor of future heart disease risk, and individual TRL and Lp(a) particles were said to pose greater risk than LDL particles. The release describes the approach but does not give sample size or details of the proteomics analysis.

Coronary heart disease develops when plaques narrow arteries; plaque rupture can cause clot, heart attack or stroke. WHO estimates cardiovascular diseases kill nearly 17.9 million people yearly, with heart attacks and strokes causing more than 80% of those deaths. Cholesterol is needed for cells, vitamins and hormones, but excess cholesterol transported by lipoproteins can accumulate in artery walls. These particles carry apolipoprotein B, and the new focus on particle type and count adds nuance to a public health message centered on LDL cholesterol as the main marker.

For people whose LDL is treated to target, the findings suggest risk may still come from other apoB-containing particles, including TRL and Lp(a). That could shape future prevention strategies, including more targeted testing or therapies, but the release does not say treatment guidelines should change now. The practical importance is that millions with controlled LDL may still need broader cardiovascular risk assessment, especially if family history or other risk factors suggest elevated Lp(a) or triglyceride-rich lipoproteins.