Assessing residual cardiovascular risk and vulnerable plaques via non-traditional lipids: From biomarkers to novel targets for precision therapy

Vollständiger Abstract

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Coronary artery disease is a leading cause of death and disability-adjusted life-years worldwide. Acute coronary syndrome, a major clinical manifestation of coronary artery disease, commonly results from disruption of vulnerable atherosclerotic plaques. Conventional lipid parameters, especially low-density lipoprotein cholesterol, play a central role in cardiovascular risk assessment and management. However, these traditional markers have important limitations in their ability to fully capture the complexity of atherosclerotic risk, particularly residual cardiovascular risk. This review comprehensively discusses the biological and pathophysiological roles of emerging non-traditional lipid-related parameters, including lipoprotein(a), low-density lipoprotein particle number and small dense low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, apolipoprotein E, apolipoprotein A1, remnant cholesterol, and polyunsaturated fatty acids in the initiation, progression and rupture of vulnerable plaques. In addition, the clinical utility of these parameters as biomarkers is critically evaluated, along with current issues in their clinical implementation and potential future research directions. Collectively, this review presents an updated framework for the advancement of precision prevention and targeted therapeutic strategies in cardiovascular disease.