High sdLDL Cholesterol can be Used to Reclassify Individuals with Low Cardiovascular Risk for Early Intervention: Findings from the Chinese Multi-Provincial Cohort Study

Abstract

A high-risk strategy has been implemented for lipid-lowering therapy in the primary prevention of cardiovascular disease. However, atherosclerosis and cardiovascular events are common among individuals with low cardiovascular risk. This study aimed to determine whether the small dense low-density lipoprotein cholesterol (sdLDLC) level can predict carotid atherosclerosis progression and identify high-risk individuals. Methods: Baseline sdLDLC and low-density lipoprotein cholesterol (LDLC) were measured in 808 particip ants from the Chinese Multi-provincial Cohort Study, aged 45 74 years. Adjusted relative risk was calculated using a modified Poisson regression model to assess the relationship between sdLDLC and 5-year atherosclerosis progression, as indicated by the progression, incidence, and multi-territorial extent of carotid plaque. Results: The 5-year atherosclerosis progression increased significantly with increased sdLDLC. Baseline sdLDLC was significantly associated with the short-term risk of plaque progression after multivariable adjustment, even in participants with low LDLC or a 10-year estimated cardiovascular risk. sdLDLC predicted plaque progression (relative risk 2.05; 95% confidence interval 1.43 2.93) in participants with LDLC 130 mg/dL. Furthermore, participants with the highest sdLDLC but intermediate or low cardiovascular risk (accounting for 16% of the cohort) had double the risk of plaque progression, which was comparable to those with the same sdLDLC and high cardiovascular risk, relative to those with the lowest sdLDLC levels and low cardiovascular risk. Conclusions: sdLDLC is independently associated with the progression of carotid atherosclerosis, which may provide a basis for clinicians to reclassify individuals believed to be at low cardiovascular risk into the high-risk category, and those with high sdLDLC may benefit from more aggressive cholesterol-lowering treatment. through the appropriate management of modifiable risk factors. Low-density lipoprotein cholesterol (LDLC) is considered as one of the most important modifiable risk factors for CVD and remains the primary target for current cardiovascular risk reduction

Relationship between the non-HDLc-to-HDLc ratio and carotid plaques in a high stroke risk population: A cross-sectional study in China

“…In fact, previous studies have demonstrated that apolipoprotein B, but not LDLc, was associated with the progression of carotid plaques [18] or the future risk of coronary heart disease [19]. Therefore, the use of LDLc to assess cholesterol-related carotid plaques risk might underestimate future cardiovascular risk compared with small dense LDLc [18]. Although we did not examine small dense LDLc in this study, to a certain extent, the use of non-HDLc to assess carotid plaques appears to be superior to LDLc as non-HDLc components include small dense LDLc.…”

“…Furthermore, these ndings from mutually adjusted models indicate that other components of non-HDLc beyond LDLc might have more contribution to carotid plaques than LDLc. In fact, previous studies have demonstrated that apolipoprotein B, but not LDLc, was associated with the progression of carotid plaques [18] or the future risk of coronary heart disease [19]. Therefore, the use of LDLc to assess cholesterol-related carotid plaques risk might underestimate future cardiovascular risk compared with small dense LDLc [18].…”

Association of small dense low-density lipoprotein with cardiovascular outcome in patients with coronary artery disease and diabetes: a prospective, observational cohort study

“…A great deal of evidence indicated that the sdLDL was related to the incidence of atherosclerotic disease [5,13,24]. Several studies in different populations using various sdLDL measurements suggested that the sdLDL was related to the carotid intima thickness and in association with progression of carotid artery plaque [25][26][27]. Wu et al reported in 2019 that elevated sdLDL concentration was observed in ACS patients (n = 121) but not in healthy controls (n = 172) [28].…”

Relationship between small dense low density lipoprotein and cardiovascular events in patients with acute coronary syndrome undergoing percutaneous coronary intervention

“…sdLDL-C has been found to be associated with increased risk for the development of CHD among the healthy participants with high or low risk of CVD [ 12 , 13 ] and increased risk for cardiovascular (CV) events in patients with stable CVD [ 14 ]. However, to date, few studies have explored the role of sdLDL-C in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI).…”