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Nearly 94 million adults in the United States have high cholesterol, which is a major risk factor for stroke and heart disease. Traditionally, high cholesterol (the risk for heart attack and stroke) has been measured by looking at levels of total cholesterol, HDL, and LDL.

Recent research suggests that another cholesterol level, known as remnant cholesterol, might also be an important predictor of heart attack and stroke risk. In fact, it could be a 40% to 50% higher risk.

The research on remnant cholesterol continues, but data suggests it might be a very important part of understanding heart disease risk.

Remnant cholesterol is the amount of cholesterol in a form of very low-density lipoproteins, called remnant lipoproteins. It can be measured by taking the value of total cholesterol minus the HDL and LDL values.

Recent research suggests that remnant cholesterol can be a useful tool for measuring your risk of heart disease and stroke.

It’s long been said that people with high levels of HDL and low levels of LDL were at a lower risk of heart disease. However new studies in 2022 and 2019 have found that levels of remnant cholesterol can be a predictor of heart disease and stroke, no matter the level of LDL.

Researchers looked at high remnant cholesterol levels independent of other heart attack and stroke risk factors, including:

They found that a high remnant cholesterol level was still able to predict heart attack and stroke risk. In fact, a high remnant cholesterol level was a predictive factor even in people with relatively low LDL and in people who did not have other major risk factors. Additionally, high remnant cholesterol was associated with a greater incidence of diabetes and obesity.

Along with LDL and HDL levels, remnant cholesterol readings may be added to your health assessment to help you and your doctor better understand your heart attack and stroke risk.

Research on remnant cholesterol is still new and ongoing. There are currently no official guidelines, averages, or standards. When this data is available, it will likely vary slightly depending on factors such as age and gender.

However, a 2021 study suggests that people with remnant cholesterol over 24 milligrams per deciliter (mg/dL) are at an increased risk of heart or stroke within the next two decades.

Calculating remnant cholesterol

You can calculate your remnant cholesterol by looking at your most recent lipid panel. To find your remnant cholesterol, take your total cholesterol and then subtract your LDL and your HDL.

For example, if your recent lipid panel had these levels:

  • Total Cholesterol: 214 mg/dL
  • LDL: 130 mg/dL
  • HDL: 35 mg/dL

Your remnant cholesterol would be 49 mg/dL based on this lipid panel. This would indicate you are at an increased risk of heart attack and stroke.

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Keep in mind, this research is still evolving. Consult your doctor about your total cholesterol and remnant cholesterol to get a better understanding of your risk.

You can take steps to lower your total cholesterol, and remnant cholesterol, by making everyday lifestyle changes. Many of these changes will decrease your total cholesterol and LDL while increasing your HDL — as a result, your remnant cholesterol will also decrease.

Steps to lower your cholesterol include:

  • Quit smoking: When you smoke, it can damage your arteries and raise your LDL. When you quit, it can increase your HDL and allows your body to repair arteries.
  • Reduce cholesterol in your diet: Eating foods with less cholesterol will help you have less cholesterol in your body.
  • Reduce unhealthy fats in your diet: A low-fat diet and heart-healthy diet can help you lower your LDL and raise your HDL.
  • Get active: Exercise can reduce your LDL and staying active can boost your HDL.
  • Maintain a healthy weight: Obesity is a risk factor for high cholesterol. Losing weight and maintaining a healthy weight can help you control your cholesterol.
  • Take any prescribed medications: Often, lifestyle changes are enough to lower cholesterol, but sometimes prescription medications can help. If your doctor prescribes cholesterol medications, it’s important to take them exactly as prescribed.

Cholesterol levels can be a predictor of heart attack and stroke risk. Traditionally, this has meant looking at total cholesterol, HDL, and LDL levels. However, new research suggests that a value called remnant cholesterol is also an important predictor of heart attack and stroke risk.

Remnant cholesterol can be calculated by subtracting HDL and LDL values from total cholesterol. Research into remnant cholesterol is ongoing, but this value might be an important part of lipid panels, and conversations about heart health, in the near future.