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REFLECTIONS
Dyslipidaemia
Dyslipidaemia Global Newsletter #10 2025

Occurrence of coronary events in the absence of traditional risk factors: Dyslipidaemia
Understanding residual risk.

Arnold N, et al. Atherosclerosis. 2025 August 9;409 :120475.

ASCVD remains a leading cause of death and disability globally, despite advances in preventive therapies and treatment strategies.
Recent data have shown that just over half of all incident CVD events were attributable to five major CV risk factors: hypertension,
diabetes, smoking, obesity, and hypercholesterolaemia. However, a significant proportion of events are not explained by them. This
reflects an unmet need for a deeper understanding of the underlying pathophysiology of ASCVD.

Using data from 21 European population-based cohorts participating in the MOnica Risk, Genetics, Archiving and Monograph
(MORGAM) and Biomarker for Cardiovascular Risk Assessment across Europe (BIOmarCare) projects, the authors examined the
occurrence of coronary events in the absence of traditional risk factors. The principal aim was to investigate the association between
baseline concentrations of five cardiometabolic biomarkers (TGs, high-sensitivity C-reactive protein [hsCRP], cystatin C, N-terminal
pro-B-type natriuretic peptide [NT-proBNP], and high-sensitivity troponin I [hs-TnI]) and the risk of future coronary heart disease
(CHD) events (defined as fatal or non-fatal myocardial infarction [MI] and/or coronary death, unstable angina pectoris, cardiac
revascularisation, and unclassifiable death) in individuals from the general population representing the full range of CVRF burden.

Graphical abstract

BM, biomarkers; CHD, coronary heart disease; CVRF,
cardiovascular risk factor; HR, hazard ratio; hsCRP,
high-sensitivity C-reactive protein; hs-TnI, high-
sensitivity troponin I; NT-proBNP, N-terminal pro-B-
type natriuretic peptide.

Overall, 212,598 participants (57% male) were stratified into having zero (n = 35,707), one (n = 68,548), and two or more (n =
108,343) traditional risk factors. Over the follow-up time of 13.97 years, 17,499 study participants developed an incident CHD event
(event rate: 20.0%). Among them, 453 events (5.8%) were observed among individuals without CVRFs at baseline. In contrast, 3045
CHD events (13.1%) occurred in individuals with one and 14,001 events (29.8%) in those with two or more risk factors at baseline.

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