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Diabetes, Cardiovascular Risks, and Lipoproteins / Atherosclerosis and Cardiovascular Diseases · Journal article
Diabetes Obesity and Metabolism · September 9, 2026
Early or partial results. Treat as a signal, not a conclusion.
This cross-sectional analysis of NHANES data found that 17.7% of U.S. adults without known ASCVD who attained PREVENT risk-stratified LDL-C goals had residual apoB elevation, which was strongly associated with triglyceride levels (adjusted OR 15.87). However, the authors acknowledge that the prognostic and clinical significance of this discordant phenotype remains unknown and requires prospective study.
Cross-sectional survey analysis. NHANES participants aged 30–79 years without known ASCVD and 10-year PREVENT-ASCVD risk ≥3% who attained risk-stratified LDL-C goals.. Intervention: Attainment of PREVENT risk-stratified LDL-C goals (exposure of interest examined). Compared with: None explicitly stated; cross-sectional comparison of those with vs. without residual ApoB elevation. n = 908. United States (National Health and Nutrition Examination Survey).
Among 908 adults with PREVENT-ASCVD risk ≥3% who attained LDL-C goals, 128 had residual ApoB elevation (weighted prevalence 17.7%, 95% CI 14.5%-21.4%) Triglycerides 150–400 mg/dL associated with 43.6% prevalence of residual ApoB elevation vs 4.3% with triglycerides <150 mg/dL (p<0.001) Adjusted OR for residual ApoB elevation with triglycerides 150–400 mg/dL was 15.87 (95% CI 8.28–30.41; p<0.001)
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This finding suggests that a substantial minority of patients reaching LDL-C targets still carry an elevated burden of atherogenic particles, particularly those with hypertriglyceridemia. Clinicians should be aware that LDL-C goal attainment alone may not reflect full lipid risk, but prospective data linking residual ApoB to outcomes are needed before clinical management recommendations can be made.
Cross-sectional observational study identifying an association between triglyceride elevation and residual apoB despite LDL-C goal attainment, but without prospective outcomes or clinical endpoint data to establish prognostic significance.
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Quoted from the source exactly as published.
This finding suggests that a substantial minority of patients reaching LDL-C targets still carry an elevated burden of atherogenic particles, particularly those with hypertriglyceridemia. Clinicians should be aware that LDL-C goal attainment alone may not reflect full lipid risk, but prospective data linking residual ApoB to outcomes are needed before clinical management recommendations can be made.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
BACKGROUND: Low-density lipoprotein cholesterol (LDL-C) goal attainment is central to primary atherosclerotic cardiovascular disease (ASCVD) prevention, but LDL-C may not fully reflect the burden of apolipoprotein B (ApoB)-containing atherogenic particles. The prevalence and clinical correlates of residual ApoB elevation among adults who have attained PREVENT risk-stratified LDL-C goals remain unclear. METHODS: This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) 2005-2016 from adults aged 30-79 years without known ASCVD. The primary analytic sample included participants with 10-year PREVENT-ASCVD risk ≥ 3% who attained risk-stratified LDL-C goals. Residual ApoB elevation was defined as ApoB ≥ 90 mg/dL for PREVENT-ASCVD risk 3% to < 10% and ≥ 70 mg/dL for risk ≥ 10%. Survey-weighted analyses were used to estimate prevalence and identify factors associated with residual ApoB elevation. RESULTS: Among 3857 adults with PREVENT-ASCVD risk ≥ 3%, 908 (23.5%) attained risk-stratified LDL-C goals. Of these, 128 had residual ApoB elevation, corresponding to a weighted prevalence of 17.7% (95% CI, 14.5%-21.4%). The prevalence was substantially higher among participants with triglycerides 150-400 mg/dL than among those with triglycerides < 150 mg/dL (43.6% vs. 4.3%; p < 0.001). In multivariable logistic regression, triglycerides of 150-400 mg/dL were strongly associated with residual ApoB elevation (adjusted OR, 15.87; 95% CI, 8.28-30.41; p < 0.001). Higher odds were also observed for PREVENT-ASCVD risk ≥ 10%, obesity, metabolic syndrome and advanced cardiovascular-kidney-metabolic stages (CKM Stages 2-4). The association with triglycerides was consistent across exploratory subgroups and robust in sensitivity analyses. CONCLUSIONS: Among U.S. adults without known ASCVD who attained PREVENT risk-stratified LDL-C goals, residual ApoB elevation was common and strongly associated with triglyceride elevation. The prognostic and clinical significance of this discordant phenotype remains to be established.
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