{
  "abstract": "Background\n\nAtherogenic lipid-related risk may not be fully characterized by a single lipid measure. A dual-axis framework combining apolipoprotein B (ApoB), a measure of atherogenic particle number, with the LDL-C to total cholesterol ratio (LDL-C/TC), a derived measure of cholesterol partitioning, has been proposed to characterize lipid-related risk heterogeneity. The position of remnant cholesterol (RC) within this framework remains uncertain.Methods\n\nWe analyzed 288,257 UK Biobank participants free of cardiovascular disease and lipid-lowering therapy. Participants were classified using dual-axis framework. Associations with incident atherosclerotic cardiovascular disease (ASCVD) were assessed using Cox models. RC was evaluated in combination with these axes across strata, including SCORE2-defined low-to-intermediate risk populations.Results\n\nOver a median follow-up of 13.9 years, the dual-axis framework differentiated ASCVD risk, with the dual-elevated phenotype (ApoB ≥ 90 mg/dL and LDL-C/TC ≥ 0.60) showing the highest risk (adjusted hazard ratio 1.23; 95% CI, 1.17-1.29). RC did not modify associations across dual-axis categories (P for interaction = 0.44), and higher RC levels were associated with attenuation of risk gradients across categories. In low-to-intermediate SCORE2 risk individuals, increasing numbers of elevated markers (ApoB, LDL-C/TC ratio, and RC) were associated with stepwise increases in risk, with absolute risk differences reaching 1.49% at 10 years for individuals with all three markers elevated versus those with none elevated. ApoB and the LDL-C/TC ratio produced small C-index increases (ΔC, 0.0013 and 0.0012), whereas RC produced no further improvement (ΔC, - 0.0001; P = 0.364).Conclusions\n\nRC did not materially modify associations across ApoB-LDL-C/TC phenotypes but identified absolute-risk heterogeneity within ApoB strata. Co-occurring marker elevations characterized higher-risk lipid phenotypes, although gains in discrimination were small and require external validation.",
  "abstract_shown": true,
  "affiliations": [
    "Medical Data Science Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, China. wangb.2023@tsinghua.org.cn.",
    "Medical Data Science Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, China. lidong15@mail.tsinghua.edu.cn."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 2,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Bin Wang",
      "orcid": "0000-0003-0012-9835"
    },
    {
      "affs": [
        1
      ],
      "name": "Dong Li"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/5bwcf0qtx6nz2.bib",
  "cited_by": 0,
  "doi": "10.1186/s12944-026-03023-z",
  "fulltext_url": "https://europepmc.org/articles/PMC13725979",
  "id": "5bwcf0qtx6nz2",
  "issns": [
    "1476-511X"
  ],
  "landing_url": "https://europepmc.org/article/MED/42968168",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Research"
    ],
    [
      "openalex",
      "2746|Lipoproteins and Cardiovascular Health"
    ]
  ],
  "openalex": "W7172395472",
  "pdf_url": "https://europepmc.org/articles/PMC13725979?pdf=render",
  "pmcid": "PMC13725979",
  "pmid": "42968168",
  "published": "2026-08-05",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/5bwcf0qtx6nz2.ris",
  "sources": [
    {
      "first_seen": "2026-11-03T15:20:53Z",
      "native_id": "MED:42968168",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42968168"
    },
    {
      "first_seen": "2026-11-05T12:22:24Z",
      "native_id": "PMC13725979",
      "source": "pmc",
      "url": "https://doi.org/10.1186/s12944-026-03023-z"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Lipoproteins and Cardiovascular Health",
      "subfield": "surgery"
    }
  ],
  "title": "Remnant cholesterol-incorporating dual-axis lipid risk stratification using apolipoprotein B and the LDL-C to total cholesterol ratio: a prospective cohort study from the UK Biobank.",
  "title_text": "Remnant cholesterol-incorporating dual-axis lipid risk stratification using apolipoprotein B and the LDL-C to total cholesterol ratio: a prospective cohort study from the UK Biobank.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-06T12:22:02Z",
  "url": "https://research.draconitic.com/paper/5bwcf0qtx6nz2",
  "venue": "Lipids in health and disease",
  "versions": []
}