{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T15:23:38Z","timestamp":1785425018240,"version":"3.56.0"},"reference-count":33,"publisher":"Vilnius University Press","issue":"1","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["AML"],"abstract":"<jats:p>Objective: To review the pathogenesis of triglycerides (TG), triglyceride-rich lipoproteins (TRL) and their remnants as well as their role in the development of atherosclerosis and clinical relevance for assessing residual ASCVD risk.Materials and methods: A literature search was conducted using keywords relevant to the topic and their combinations. A targeted PubMed search prioritized English-language guidelines, consensus statements, randomized clinical trials, cohort studies, and meta-analyses published between 2019 and 2025, with older landmark publications included where necessary. Reference lists of key articles were also manually screened to identify additional relevant studies.Results: The literature shows that elevated TG concentrations are associated with a higher risk of ASCVD, regardless of LDL-C. Given that no clear signal indicates which features of TRL give rise to risk of ASCVD, plasma TG levels remain a reasonable surrogate marker for risk assessment. Evidence suggests that the atherogenicity of TRL is driven primarily by the cholesterol carried within TRL and their remnants rather than TG themselves. TRL remnants may be at least as atherogenic as, and potentially more atherogenic than, low-density lipoproteins (LDL) because they can be taken up by intimal macrophages without prior oxidative or structural modification, persist longer within the intima, are larger in size, and carry more cholesterol per particle. They also more effectively promote foam-cell formation and contribute to low-grade inflammation. Given the conflicting results of large-scale randomized clinical trials, it is not yet possible to conclude that lowering TG concentrations alone reduces the ASCVD risk.Conclusions: Elevated plasma TG concentrations are associated with an increased risk of ASCVD, independent of LDL-C levels. Given the ongoing need to identify the most reliable metric for risk stratification, TG remain a rational surrogate marker for estimating residual ASCVD risk related to TRL and their remnants.<\/jats:p>","DOI":"10.15388\/amed.2026.33.1.4","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T05:34:37Z","timestamp":1784698477000},"page":"48-57","source":"Crossref","is-referenced-by-count":0,"title":["The Role of Triglycerides in the Development of Atherosclerosis"],"prefix":"10.15388","volume":"33","author":[{"given":"Vaida","family":"Cerebiej\u016bt\u0117","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03nadee84","id-type":"ROR","asserted-by":"publisher"}],"name":"Vilnius University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6471-7851","authenticated-orcid":false,"given":"\u017divil\u0117","family":"Girkantait\u0117","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0590pq693","id-type":"ROR","asserted-by":"publisher"}],"name":"Vilnius University Hospital Santariskiu Klinikos"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4362-8143","authenticated-orcid":false,"given":"Egidija","family":"Rink\u016bnien\u0117","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03nadee84","id-type":"ROR","asserted-by":"publisher"}],"name":"Vilnius University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6451-7306","authenticated-orcid":false,"given":"Silvija","family":"Gim\u017eauskait\u0117","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03nadee84","id-type":"ROR","asserted-by":"publisher"}],"name":"Vilnius University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jolita","family":"Badarien\u0117","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03nadee84","id-type":"ROR","asserted-by":"publisher"}],"name":"Vilnius University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6097","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"Yanai H, Adachi H, Hakoshima M, Katsuyama H. Atherogenic lipoproteins for the statin residual cardiovascular disease risk. Int J Mol Sci. 2022;23(21):13499. doi:10.3390\/ijms232113499","DOI":"10.3390\/ijms232113499"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Mach F, Baigent C, Catapano AL, et al. 2019 ESC\/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41(1):111-188. doi:10.1093\/eurheartj\/ehz455","DOI":"10.1093\/eurheartj\/ehz455"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Jebari-Benslaiman S, Galicia-Garc\u00eda U, Larrea-Sebal A, et al. Pathophysiology of Atherosclerosis. Int J Mol Sci. 2022;23(6):3346. doi:10.3390\/ijms23063346","DOI":"10.3390\/ijms23063346"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Hansen SEJ, Madsen CM, Varbo A, Nordestgaard BG. Low-Grade inflammation in the association between mild-to-moderate hypertriglyceridemia and risk of acute pancreatitis: a study of more than 115000 individuals from the general population. Clin Chem. 2019;65(2):321-332. doi:10.1373\/clinchem.2018.294926","DOI":"10.1373\/clinchem.2018.294926"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Pint\u00f3 X, Fanlo M, Esteve V, et al. Colesterol remanente, riesgo vascular y prevenci\u00f3n de la arteriosclerosis. Cl\u00edn Investig Arterioscler. 2023;35(4):206-217. doi:10.1016\/j.arteri.2023.02.001","DOI":"10.1016\/j.arteri.2023.02.001"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Shi F, Dou J, Zhang X. Advancements in research to mitigate residual risk of atherosclerotic cardiovascular disease. Eur J Med Res. 2025;30(1):735. doi:10.1186\/s40001-025-03006-3","DOI":"10.1186\/s40001-025-03006-3"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Farnier M, Zeller M, Masson D, Cottin Y. Triglycerides and risk of atherosclerotic cardiovascular disease: An update. Arch Cardiovasc Dis. 2021;114(2):132-139. doi:10.1016\/j.acvd.2020.11.006","DOI":"10.1016\/j.acvd.2020.11.006"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Zheng WC, Chan W, Dart A, Shaw JA. Novel therapeutic targets and emerging treatments for atherosclerotic cardiovascular disease. Eur Heart J Cardiovasc Pharmacother. 2024;10(1):53-67. doi:10.1093\/ehjcvp\/pvad074","DOI":"10.1093\/ehjcvp\/pvad074"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Quispe R, Sweeney T, Varma B, Agarwala A, Michos ED. Recent Updates in Hypertriglyceridemia Management for Cardiovascular Disease Prevention. Curr Atheroscler Rep. 2022;24(10):767-778. doi:10.1007\/s11883-022-01052-4","DOI":"10.1007\/s11883-022-01052-4"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Raposeiras-Roubin S, Rossell\u00f3 X, Oliva B, et al. Triglycerides and residual atherosclerotic risk. J Am Coll Cardiol. 2021;77(24):3031-3041. doi:10.1016\/j.jacc.2021.04.059","DOI":"10.1016\/j.jacc.2021.04.059"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Drexel H, Mader A, Larcher B, et al. Remnant cholesterol and long-term incidence of death in coronary artery disease patients. Atherosclerosis. 2025;401:119048. doi:10.1016\/j.atherosclerosis.2024.119048","DOI":"10.1016\/j.atherosclerosis.2024.119048"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Li X, Li ZF, Wu NQ. Remnant Cholesterol and Residual Risk of Atherosclerotic Cardiovascular Disease. Rev Cardiovasc Med. 2025;26(2):25985. doi:10.31083\/RCM25985","DOI":"10.31083\/RCM25985"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Nordestgaard BG, Varbo A. Triglycerides and cardiovascular disease. The Lancet. 2014;384(9943):626-635. doi:10.1016\/S0140-6736(14)61177-6","DOI":"10.1016\/S0140-6736(14)61177-6"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Heo JH, Jo SH. Triglyceride-rich lipoproteins and remnant cholesterol in cardiovascular disease. J Korean Med Sci. 2023;38(38):e295. doi:10.3346\/jkms.2023.38.e295","DOI":"10.3346\/jkms.2023.38.e295"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Aaseth E, Halvorsen S, Helseth R, Gravning J. Remnant cholesterol, plasma triglycerides, and risk of cardiovascular disease events in young adults: a prospective cohort study. Eur J Prev Cardiol. 2025;32(13):1181-1189. doi:10.1093\/eurjpc\/zwaf104","DOI":"10.1093\/eurjpc\/zwaf104"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Ginsberg HN, Packard CJ, Chapman MJ, et al. 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. Eur Heart J. 2021;42(47):4791-4806. doi:10.1093\/eurheartj\/ehab551","DOI":"10.1093\/eurheartj\/ehab551"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Koo BK, Park S, Han KD, Moon MK. Hypertriglyceridemia is an independent risk factor for cardiovascular diseases in Korean adults aged 30-49 years: a nationwide population-based study. J Lipid Atheroscler. 2021;10(1):88-98. doi:10.12997\/jla.2021.10.1.88","DOI":"10.12997\/jla.2021.10.1.88"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"Simha V. Management of hypertriglyceridemia. BMJ. 2020;371:m3109. doi:10.1136\/bmj.m3109","DOI":"10.1136\/bmj.m3109"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Expert Panel On Detection, Evaluation, And Treatment Of High Blood Cholesterol In Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486-2497. doi:10.1001\/jama.285.19.2486","DOI":"10.1001\/jama.285.19.2486"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"Berglund L, Brunzell JD, Goldberg AC, et al. Evaluation and treatment of hypertriglyceridemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012;97(9):2969-2989. doi:10.1210\/jc.2011-3213","DOI":"10.1210\/jc.2011-3213"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA\/ACC\/AACVPR\/AAPA\/ABC\/ACPM\/ADA\/AGS\/APhA\/ASPC\/NLA\/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139(25):e1082-e1143. doi:10.1161\/CIR.0000000000000625","DOI":"10.1161\/CIR.0000000000000625"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"Rosenson RS, Shaik A, Song W. New therapies for lowering triglyceride-rich lipoproteins. J Am Coll Cardiol. 2021;78(18):1817-1830. doi:10.1016\/j.jacc.2021.08.051","DOI":"10.1016\/j.jacc.2021.08.051"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"Salinas CAA, Chapman MJ. Remnant lipoproteins: are they equal to or more atherogenic than LDL? Curr Opin Lipidol. 2020;31(3):132-139. doi:10.1097\/MOL.0000000000000682","DOI":"10.1097\/MOL.0000000000000682"},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"Baratta F, Cocomello N, Coronati M, et al. Cholesterol remnants, triglyceride-rich lipoproteins and cardiovascular risk. Int J Mol Sci. 2023;24(5):4268. doi:10.3390\/ijms24054268","DOI":"10.3390\/ijms24054268"},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"Nordestgaard BG. Triglyceride-rich lipoproteins and atherosclerotic cardiovascular disease: new insights from epidemiology, genetics, and biology. Circ Res. 2016;118(4):547-563. doi:10.1161\/CIRCRESAHA.115.306249","DOI":"10.1161\/CIRCRESAHA.115.306249"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"Mach F, Koskinas KC, Roeters Van Lennep JE, et al. 2025 Focused Update of the 2019 ESC\/EAS Guidelines for the management of dyslipidaemias. Eur Heart J. 2025;46(42):4359-4378. doi:10.1093\/eurheartj\/ehaf190","DOI":"10.1093\/eurheartj\/ehaf190"},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"Nicholls SJ, Lincoff AM, Garcia M, et al. Effect of high-dose omega-3 fatty acids vs corn oil on major adverse cardiovascular events in patients at high cardiovascular risk: the STRENGTH randomized clinical trial. JAMA. 2020;324(22):2268-2280. doi:10.1001\/jama.2020.22258","DOI":"10.1001\/jama.2020.22258"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"Doi T, Langsted A, Nordestgaard BG. Remnant cholesterol, LDL cholesterol, and apoB absolute mass changes explain results of the PROMINENT trial. Atherosclerosis. 2024;393:117556. doi:10.1016\/j.atherosclerosis.2024.117556","DOI":"10.1016\/j.atherosclerosis.2024.117556"},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"Burger PM, Bhatt DL, Dorresteijn JAN, et al. Effects of icosapent ethyl according to baseline residual risk in patients with atherosclerotic cardiovascular disease: results from REDUCE-IT. Eur Heart J Cardiovasc Pharmacother. 2024;10(6):488-499. doi:10.1093\/ehjcvp\/pvae030","DOI":"10.1093\/ehjcvp\/pvae030"},{"key":"ref29","doi-asserted-by":"publisher","unstructured":"Bhatt DL, Steg PG, Miller M, et al. Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia. N Engl J Med. 2019;380(1):11-22. doi:10.1056\/NEJMoa1812792","DOI":"10.1056\/NEJMoa1812792"},{"key":"ref30","doi-asserted-by":"publisher","unstructured":"Laufs U, Parhofer KG, Ginsberg HN, Hegele RA. Clinical review on triglycerides. Eur Heart J. 2020;41(1):99-109c. doi:10.1093\/eurheartj\/ehz785","DOI":"10.1093\/eurheartj\/ehz785"},{"key":"ref31","doi-asserted-by":"publisher","unstructured":"Delialis D, Georgiopoulos G, Aivalioti E, et al. Remnant cholesterol in atherosclerotic cardiovascular disease: A systematic review and meta-analysis. Hellenic J Cardiol. 2023;74:48-57. doi:10.1016\/j.hjc.2023.04.007","DOI":"10.1016\/j.hjc.2023.04.007"},{"key":"ref32","doi-asserted-by":"publisher","unstructured":"Varbo A, Nordestgaard BG. Directly measured vs. calculated remnant cholesterol identifies additional overlooked individuals in the general population at higher risk of myocardial infarction. Eur Heart J. 2021;42(47):4833-4843. doi:10.1093\/eurheartj\/ehab293","DOI":"10.1093\/eurheartj\/ehab293"}],"container-title":["Acta medica Lituanica"],"original-title":[],"link":[{"URL":"https:\/\/zurnalai.vu.lt\/\/AML\/article\/download\/45697\/42898","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/zurnalai.vu.lt\/\/AML\/article\/download\/45697\/42922","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/zurnalai.vu.lt\/\/AML\/article\/download\/45697\/42898","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T10:03:08Z","timestamp":1784714588000},"score":1,"resource":{"primary":{"URL":"https:\/\/zurnalai.vu.lt\/\/AML\/article\/view\/45697"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,22]]},"references-count":33,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,7,22]]}},"URL":"https:\/\/doi.org\/10.15388\/amed.2026.33.1.4","relation":{},"ISSN":["2029-4174","1392-0138"],"issn-type":[{"value":"2029-4174","type":"electronic"},{"value":"1392-0138","type":"print"}],"subject":[],"published":{"date-parts":[[2026,7,22]]}}}