Prognostic Implication of Small Dense LDL-Cholesterol Levels following Acute Coronary Syndrome

Abstract

Background and Objectives: Small dense LDL cholesterol is a strong risk factor for atherosclerosis. However, few studies have investigated the impacts of this specific lipid profile on the incident risk of adverse cardiovascular events in patients with acute coronary syndrome. Materials and Methods: Patients with acute coronary syndrome, who underwent revascularization, were included and followed for 2 years. The levels of small dense LDL cholesterol were measured at index discharge (day 0) in the setting of newly administered therapies for secondary prevention, including aspirin and statins, during the index hospitalization. The prognostic impact of small dense LDL-cholesterol levels on the risk of a primary composite endpoint, including cardiac death, non-fatal myocardial infarction, unstable angina pectoris, stroke, and heart failure, was investigated. Results: In total, 46 patients (median 75 (59, 83) years old, 63% men) were included. Median small dense LDL cholesterol was 19.4 (13.5, 23.8) mg/dL at index discharge. All patients initiated statin treatment before the index discharge, with a median LDL-cholesterol level of 77 (64, 109) mg/dL. Small dense LDL-cholesterol level was independently associated with an incremental risk for the primary endpoint (p < 0.05 by adjusting for several potential risk factors, including LDL cholesterol) with a cutoff of 32.6 mg/dL. Conclusions: Small dense LDL-cholesterol level was a significant risk factor for cardiovascular events following presentations of acute coronary syndrome.

Impact of Pemafibrate Therapy on Reducing Small Dense Low-Density-Lipoprotein-Cholesterol Levels in Patients with Hypertriglyceridemia

“…The therapeutic target level for small dense LDL-cholesterol is another concern. A previous study suggested a cutoff of 20.9 mg/dL for secondary prevention in patients with acute coronary syndrome, [25] while another study proposed a cutoff of 32.6 mg/dL in a similar cohort [26]. The median value of small dense LDL-cholesterol in our study was 38.8 mg/dL.…”

Estimation of Small Dense LDL-Cholesterol Levels in Patients with Acute Coronary Syndrome

“…8) We have further demonstrated its validity in another clinically important scenario, acute coronary syndrome, where small dense LDL-cholesterol levels may provide an additional tool for risk stratification. [9][10][11] Predictability was not affected by the presence of baseline statin use. Given the lack of an on-label measurement of small dense LDL-cholesterol levels, the Sampson equation may be a feasible method to measure and track in patients presenting with acute coronary syndrome.…”

“…Several cutoff values for small dense LDL-cholesterol have been proposed to predict clinical outcomes after acute coronary syndrome. [9][10][11] In patients at a high baseline risk of adverse cardiovascular events, incorporating the measurement of small dense LDL particles should be considered by practitioners as an additional risk modifier when making clinical decisions about lipidlowering therapies. A high proportion of patients may not have exceedingly unacceptable LDL-cholesterol levels but instead have a higher percentage of small dense LDLcholesterol, for which further intensification of therapies should be considered.…”

“…8) Another clinical scenario that may be relevant to the study of small dense LDL-cholesterol levels is acute coronary syndrome. [9][10][11] There is limited data as to what distribution of small dense LDL-cholesterol are present in patients with acute coronary syndrome. In this study, we investigated the validity of the Sampson equation for estimating small dense LDL-cholesterol in patients with acute coronary syndrome.…”