Research Progress of Remnant Cholesterol in Atherosclerotic Cardiovascular Disease

动脉粥样硬化性心血管疾病是全球公共卫生领域的主要致死致残病因，每年造成重大疾病负担。其病理生理基础与脂代谢紊乱高度相关，尽管当前指南推荐的他汀类药物可有效控制低密度脂蛋白胆固醇至目标范围(如Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality in the field of global public health, imposing a significant disease burden annually. Its pathological basis is closely associated with lipid metabolism disorders. Although current guidelines recommend statins to effectively control low-density lipoprotein cholesterol (LDL-C) to target levels (e.g., <1.8 mmol/L), patients still face a high residual cardiovascular risk. Recent evidence-based medical studies suggest that this residual risk may be closely linked to an emerging lipid marker—remnant cholesterol (RC). As a core component of triglyceride-rich lipoprotein remnants (such as very low-density lipoprotein and intermediate-density lipoprotein), RC can accelerate the progression of atherosclerotic plaques through multiple pathways, including pro-inflammatory, pro-oxidative, and endothelial dysfunction mechanisms. This article systematically reviews recent advances in the definition of RC, standardized measurement methods, its molecular mechanisms in plaque vulnerability, and findings from large-scale cohort studies.