Abstract
The roles of triglycerides (TGs), triglyceride-rich lipoproteins (TRLs), and remnant cholesterol (RC) in cardiovascular disease have garnered increasing attention, particularly in light of the persistent residual cardiovascular risk that remains despite effective low-density lipoprotein cholesterol (LDL-C) management. Recent studies indicate that TGs and RC contribute to atherosclerosis independently of LDL-C. This review examines TG metabolism, the unique atherogenic properties of TRLs, and the mechanistic and clinical implications of RC in atherosclerosis. We critically evaluate whether TGs themselves are direct drivers of heart disease or whether the pathological effects arise mainly from TRL remnants and their cholesterol content. Furthermore, we review current and emerging therapeutic strategies targeting these lipid components and propose future directions for integrating TG and RC metrics into clinical risk management.