ArticleFrontiers in public health2026
Cross-population heterogeneity in the association between estimated sdLDL-C and gallstone disease: a dual-source two-sample cross-sectional study.
Article in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: While conventional lipid parameters are linked to gallstone disease, the specific role of small dense low-density lipoprotein cholesterol (sdLDL-C)-a highly atherogenic subfraction-remains unexplored. We aimed to evaluate the independent association between estimated sdLDL-C and gallstone risk, and to map potential cross-population dose-response relationships. Methods: This dual-source cross-sectional study integrated a strictly defined Chinese clinical sample ( Results: In the multivariable-adjusted models, when analyzed as a continuous variable, elevated estimated sdLDL-C was significantly and positively associated with gallstone risk in both the Chinese sample (OR = 1.12, 95% CI: 1.08-1.15) and the NHANES cohort (OR = 1.03, 95% CI: 1.01-1.04). Sensitivity analysis excluding individuals with diabetes and hypertension confirmed the stability of this positive association (OR = 1.11, 95% CI: 1.07-1.15). Dose-response analysis revealed a non-linear threshold effect in the Chinese sample, with an inflection point at 34.51 mg/dL (sdLDL-C ≥ 34.51 mg/dL: OR = 1.27, 95% CI: 1.20-1.34, Conclusion: Estimated sdLDL-C exhibits an independent and positive association with gallstone disease, suggesting it might be more than merely a secondary manifestation of late-stage metabolic syndrome. The identification of a specific non-linear threshold in the Chinese population, juxtaposed with a linear pattern in the US, suggests the potential value of exploring sdLDL-C for risk stratification in biliary diseases, though these cross-sectional findings require prospective validation.
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