Assessing residual cardiovascular risk and vulnerable plaques via non-traditional lipids: From biomarkers to novel targets for precision therapy

Table 1 Comparison of traditional and non-traditional lipid parameters in cardiovascular disease risk assessment

Parameter type	Representative markers	Main characteristics	Advantages	Limitations	Role in residual risk
Traditional lipid parameters	TC, LDL-C, HDL-C, TG	Concentrations of cholesterol and triglycerides	Widely available; inexpensive; guideline-endorsed; LDL-C lowering reduces ASCVD events[7]	Cannot reflect particle number, composition, or other atherogenic lipoproteins; may underestimate residual risk[7]	Significant residual risk persists despite optimal LDL-C control
Non-traditional lipid parameters	Lp(a), LDL-P, sdLDL-C, non-HDL-C, ApoE, ApoA1, RC, PUFAs	Reflect lipoprotein quantity, quality, function and metabolism	Associated with plaque vulnerability[10,11]	Limited standardization; higher cost; limited availability; evidence for some markers remains observational[7,9]	May improve residual risk identification[12]

TC: Total cholesterol; LDL-C: Low-density lipoprotein cholesterol; HDL-C: High-density lipoprotein cholesterol; TG: Triglyceride; Lp(a): Lipoprotein(a); LDL-P: Low-density lipoprotein particle number; sdLDL-C: Small dense low-density lipoprotein cholesterol; ApoE: Apolipoprotein E; ApoA1: Apolipoprotein A1; RC: Remnant cholesterol; PUFAs: Polyunsaturated fatty acids; ASCVD: Atherosclerotic cardiovascular disease.