Journal Article Review Epublish
PubMed: 42325672 DOI: 10.3389/fcvm.2026.1837004
Managing remnant cholesterol: role of fenofibrate-statin therapy in reducing triglyceride-rich lipoproteins.
Front Cardiovasc Med 13:1837004
Authors: Vikrama Raja, Carlos Aguiar, Nasreen Alsayed, Yogeyaa S Chibber, Hussein ElBadawi, Michel Farnier, Kumari Pushpa, Lale Tokgözoglu, Alberto Zambon, Jean-Pascal Berrou, Michel P Hermans
Affiliations
- Medical Affairs, Abbott Products Operations AG, Basel, Switzerland.
- Department of Cardiology, Hospital Santa Cruz, Western Lisbon Local Health Unit, Lisbon, Portugal.
- Department of Endocrinology, Diabetes & Metabolism, Dar Alsaha Medical Center, Manama, Kingdom of Bahrain.
- Medical Affairs, WNS Global Services, Noida, India.
- Internal Medicine Department, Wayne State University, Detroit, MI, U.S.A. Metabolic Unit, My Clinic International, Jeddah, Saudi Arabia.
- Université Bourgogne Europe, PEC2 UR 7460, Dijon, France.
- Department of Cardiology, Hacettepe University, Ankara, Turkiye.
- Department of Medicine, University of Padua, Padua, Italy.
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.
Abstract
Dyslipidemia, a key risk factor for atherosclerotic cardiovascular disease (ASCVD), is conventionally managed by lowering low-density lipoprotein cholesterol (LDL-C) level. However, even with on-target LDL-C and optimal control of traditional risk factors such as hypertension and diabetes, a substantial residual risk of major adverse cardiovascular events (MACE) persists. A growing body of evidence suggests that remnant cholesterol (RC) - the cholesterol content of triglyceride-rich lipoproteins (TRLs) - partially contributes to this residual risk. Consequently, non-high-density lipoprotein cholesterol (non-HDL-C) is considered a better measure of the ASCVD risk and a comprehensive treatment goal for dyslipidemia. Statin therapy, the standard care for dyslipidemia management, falls short of mitigating RC-related residual risk. The global rise in obesity, type 2 diabetes, and metabolic syndrome has led to a growing prevalence of hypertriglyceridemia, underscoring the need for adjunctive therapies that target TRLs and lower non-HDL-C levels. Fenofibrate, a well-established TRL-lowering agent, has demonstrated efficacy in reducing non-HDL-C when used in combination with statins. Evidence from clinical trials and real-world studies suggests potential benefits of this combination in reducing cardiovascular risk, particularly in patients with elevated triglyceride levels. Moreover, long-term studies - spanning up to two decades -have affirmed the safety and tolerability of fenofibrate, reinforcing its role as a valuable add-on therapy to address remnant cholesterol and residual cardiovascular risk.
MeSH
Diabetes Mellitus, Cholesterol, Ldl, Lipoproteins, Dyslipidemias, Cholesterol, Risk Factors, Therapeutics, Hydroxymethylglutaryl-Coa Reductase Inhibitors, Triglycerides, Fenofibrate