ArticleArteriosclerosis, thrombosis, and vascular biology2025
Estimated Small, Dense LDL Cholesterol and Atherosclerotic Cardiovascular Risk in the UK Biobank.
Article in Arteriosclerosis, thrombosis, and vascular biology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed.
- Article
- Low levels of low-density lipoprotein cholesterol in older adults are inversely associated with the incidence of coronary artery disease and all-cause mortality: the Shizuoka Kokuho Database study.European geriatric medicine · 2026Article
- The small dense LDL cholesterol-glucose index combined with visceral adiposity (sdLG-cVAI) as a novel predictor of incident cardiovascular disease: a prospective cohort study.Lipids in health and disease · 2026Article
- LDL-C combined with Chinese visceral adiposity index as a risk stratification tool for cardiometabolic multimorbidity in middle-aged and older Chinese adults: a national prospective cohort study.Cardiovascular diabetology · 2026Article
- Role of combined serum homocysteine and small dense LDL-C in predicting cardiovascular events in obesity: a retrospective clinical study.BMC cardiovascular disorders · 2026Article
- New Methods for Calculating LDL-Cholesterol and Related Biomarkers of Atherosclerotic Cardiovascular Disease Risk.Current atherosclerosis reports · 2026Review
- Clinical utility of lipoprotein(a) and the ApoB/ApoA-I ratio in the risk assessment of acute coronary syndrome: from single biomarkers to integrated risk stratification.Frontiers in cardiovascular medicine · 2026Review
- Association of lipoprotein indices with 3-month functional outcome after ischemic stroke: a retrospective cohort study.Frontiers in nutrition · 2026Article
- Estimated small dense low-density lipoprotein cholesterol and hyperuricemia in diabetic patients.Frontiers in endocrinology · 2026Article
- Association between triglyceride-glucose index combined with a body shape index and atherosclerotic cardiovascular disease risk varies by glycemic status: insights from the UK Biobank.Cardiovascular diabetology · 2025Article
- Patterns of lipid profile and genetic variations in South Asians.Cardiovascular diabetology. Endocrinology reports · 2025Review
- LDL atherogenicity determined by size, density, oxidation, apolipoprotein(a), and electronegativity: an updated review.Frontiers in cardiovascular medicine · 2025Review
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4 authors.
Funding
Abstract
backgroundA key step in primary prevention is the assessment of atherosclerotic cardiovascular disease (ASCVD) risk. Risk enhancer tests are additional tools used to further improve ASCVD risk assessment over conventional risk markers. Our objective was to determine whether estimated small, dense low-density lipoprotein cholesterol (E-sdLDL-C) can improve risk assessment and serve as a new risk enhancer test.
methodsWe used a prospective cohort analysis of participants in the UK Biobank study with a median (interquartile range) follow-up of 10 (6.7-12.3) years. We included 271 760 individuals who were not on lipid-lowering medication at baseline and did not have incident ASCVD. The primary study outcome was the incidence of all-cause ASCVD.
resultsE-sdLDL-C was strongly associated with ASCVD events with a hazard ratio (HR) of 1.23 (95% CI, 1.22-1.24). After multivariable adjustment for age, sex, systolic blood pressure, hypertension, type 2 diabetes, and blood pressure medications, E-sdLDL-C and ApoB (apolipoprotein B) remained the most significant lipid risk factors (HR, 1.18 [95% CI, 1.16-1.19] and 1.17 [95% CI, 1.16-1.18] per SD, respectively). After further adjustment for ApoB, the association between low-density lipoprotein cholesterol (LDL-C) with all-cause ASCVD was completely reversed with an HR of 0.84 (95% CI, 0.81-0.86), but E-sdLDL-C continued to have a significant positive association with an HR of 1.11 (95% CI, 1.08-1.13). When E-sdLDL-C was discordantly higher than either LDL-C or ApoB, the risk for ASCVD was higher (LDL-C, 31% higher; ApoB, 17% higher). When elevated E-sdLDL-C is coupled with other risk enhancer tests, there is a greater risk for developing ASCVD.
conclusionsIn a UK Biobank cohort for primary prevention, the risk of all-cause ASCVD was better captured by E-sdLDL-C than LDL-C. It was also more predictive than LDL-C and ApoB when discordant with these 2 measures. E-sdLDL-C, which can be freely and automatically calculated from a standard lipid panel, can potentially improve ASCVD risk assessment without additional laboratory testing.
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