{"id":"2a15b09d4e68","type":"article","url":"https://hartvaat.nl/2026/05/14/lipidegerelateerd-cv-risico-voorbij-ldl-focus-verschuift-naar-remnant-cholestero/","title":"Lipidegerelateerd CV-risico voorbij LDL: focus verschuift naar remnant-cholesterol en Lp(a)","title_en":"","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts","internist"],"tags":["bempedoïnezuur","dyslipidemie","ezetimibe","familiaire-hypercholesterolemie-screening","hdl-cholesterol","ldl-cholesterol","lipide-aferese","lipidenverlaging","lipoproteïne-a","lipoproteïne-a-therapeutisch-doel","niet-statine-therapie","statines"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2025-326404","source_url":"https://doi.org/10.1136/heartjnl-2025-326404","authors":["Mie Balling","Karen Hvid","Anette Varbo","Anne Langsted","Borge G Nordestgaard","Shoaib Afzal"],"significance":6,"published":"2026-06-20","source_date":"2026-05-14","image":"https://hartvaat.nl/global/img/737cbe5a1f5d.webp","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/"],"congress":"","summary_en":"Heart review of lipid-related cardiovascular risk beyond LDL cholesterol. While LDL lowering has been the dominant target for decades, mechanistic, observational, and genetic studies support a causal role for remnant particles and lipoprotein(a) in ASCVD development. Multiple new drugs targeting these are now in development with RCT results expected. Lipoprotein(a) is largely genetically determined; remnant cholesterol correlates strongly with overeating, obesity, and diabetes. The global obesity epidemic is driving an increase in metabolic dyslipidaemias and related ASCVD risk. The era of LDL-only risk management is over — targeted approaches to metabolically dysregulated and genetically driven lipid fractions are becoming increasingly important.","created":"2026-07-03T10:33:05Z","updated":"2026-07-03T13:31:59Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Overzichtsartikel in Heart over cardiovasculair risico door lipiden naast LDL-cholesterol. Hoewel LDL-verlaging decennia het dominante doel is geweest, ondersteunen mechanistische, observationele en genetische data een causale rol van remnant-particles en lipoproteïne(a) in de ontwikkeling van ASCVD. Daarop richten zich nu meerdere nieuwe geneesmiddelen waarvan RCT-resultaten worden verwacht. Lipoproteïne(a) is grotendeels genetisch bepaald; remnant cholesterol correleert sterk met overeten, obesitas en diabetes. Door de wereldwijde obesitas-epidemie nemen metabole dyslipidemieën en daarmee samenhangende ASCVD-risico's toe. Het tijdperk van uitsluitend LDL-gestuurd risicomanagement is daarmee voorbij — gerichte aanpak van metabool ontregelde en genetisch gedreven lipidenfracties wordt steeds belangrijker.","abstract_original":"The aim of this review is to give an overview of lipid-related risk of atherosclerotic cardiovascular disease (ASCVD) beyond low-density lipoprotein (LDL) cholesterol. High LDL cholesterol is a key driver of ASCVD as shown in several interventional, mechanistic, observational and genetic studies. Therefore, the focus has for decades been on lowering LDL cholesterol levels. Attention is now shifting beyond LDL cholesterol towards additional risk measures. Mechanistic, observational and genetic studies support a causal role of elevated remnant particles and high lipoprotein(a) in the development of ASCVD, which has led pharmaceutical companies to develop new potential drugs targeting these lipoproteins. In the coming years results from randomised controlled trials with these drugs are expected. Furthermore, with rates of obesity, insulin resistance, diabetes and the metabolic syndrome increasing worldwide, the use of lipid measurements capturing risk in addition to LDL cholesterol is more relevant than ever. Lipoprotein(a) levels are genetically determined while remnant cholesterol levels are highly correlated to overeating, obesity and diabetes. In a future population with higher risk of ASCVD given the obesity pandemic it will have growing importance to target lipids involved in metabolic dysregulation and lipids that are genetic drivers of ASCVD."}