Triglyceride-rich lipoproteins and their remnants: metabolic insights, role in atherosclerotic cardiovascular disease, and emerging therapeutic strategies—a consensus statement from the European Atherosclerosis Society

For decades, triglycerides (TG) have been considered a putative riskfactor for atherosclerotic cardiovascular disease (ASCVD). Despite mounting evidence from population and genetic studies, controversy persists. Much of this relates to two key questions: first, which is the culprit(s): TG molecules per se, TG-rich lipoproteins(TRL), or TRL remnants, and second, for TRL or their remnants, which components give rise to risk: cholesterol contained in these particles, other features, or both? Answers are essential to understand better the pathological consequences of raised TG levels, especially in the context of residual cardiovascular risk when other major factors, particularly low-density lipoprotein cholesterol (LDL-C), are optimally controlled. This statement aims to define what is known about the structure, function, metabolism, and atherogenicity of TRL and their remnants, and importantly, to identify targeted therapeuticapproaches to address residual risk associated with elevated TG levels.