Related Experiment Video
Updated: May 1, 2026
Differential Effects of Lipid-lowering Drugs in Modulating Morphology of Cholesterol Particles
Published on: November 10, 2017
Elevated small dense low-density lipoprotein cholesterol as a predictor for future cardiovascular events in patients
Tenjin Nishikura1, Shinji Koba, Yuya Yokota
1The Department of Medicine, Division of Cardiology, Showa University School of Medicine.
Insights
Small dense low-density lipoprotein cholesterol (sdLDL-C) is a better predictor of cardiovascular events in stable coronary artery disease (CAD) patients than LDL-C. Higher sdLDL-C levels indicate a poorer long-term prognosis, highlighting its value in secondary prevention.
Area of Science:
- Cardiology
- Lipid Metabolism
- Atherosclerosis Research
Background:
- Coronary artery disease (CAD) management relies on risk stratification.
- Low-density lipoprotein cholesterol (LDL-C) is a known risk factor, but its predictive power may be limited.
- Small dense LDL cholesterol (sdLDL-C) is a subtype of LDL-C with potentially different prognostic implications.
Purpose of the Study:
- To compare the prognostic value of sdLDL-C versus LDL-C in patients with stable CAD.
- To assess the association of sdLDL-C levels with long-term cardiovascular event risk.
Main Methods:
- 190 stable CAD patients underwent coronary arteriography (2003-2004).
- sdLDL-C and LDL particle size were measured.
- Seven-year follow-up assessed cardiovascular events (death, ACS, revascularization, heart failure, stroke).
Main Results:
- Patients with cardiovascular events had higher sdLDL-C levels and smaller LDL particle sizes.
- sdLDL-C levels (≥35 mg/dL) were significantly associated with poorer prognosis.
- LDL-C levels (≥100 mg/dL) showed a non-significant trend towards lower survival.
Conclusions:
- sdLDL-C is a superior biomarker for predicting future cardiovascular events in stable CAD.
- sdLDL-C holds significant promise for secondary prevention strategies in CAD patients.
Aim:
The aim of the present study was to investigate how small dense low-density lipoprotein cholesterol (sdLDL-C) compared with LDL-C affect the long-term prognosis in patients with stable coronary artery disease (CAD).
Methods:
sdLDL-C measured by heparin magnesium precipitation and LDL particle size measured by non-denatured gradient-gel electrophoresis were compared in 190 consecutive CAD patients who underwent coronary arteriography between 2003 and 2004 who did or did not develop cardiovascular events during a seven-year follow-up period. Cardiovascular events were death caused by cardiovascular diseases(CVDs), onset of acute coronary syndrome, need for coronary and peripheral arterial revascularization, hospitalization for heart failure, surgical procedure for any CVDs, and/or hospitalization for stroke.
Results:
First-time cardiovascular events were observed in 72 patients. Those who experienced cardiovascular events were older and had higher prevalence rates of hypertension and diabetes; significantly higher Gensini coronary atherosclerotic scores; significantly higher levels of sdLDL-C, sdLDL-C/LDL-C, and LDL-C/high-density lipoprotein cholesterol (HDL-C) ratios; and greater glycated hemoglobin(Hb)A1c and brain natriuretic peptide (BNP) levels. They also had significantly smaller LDL particle sizes, HDL-C, apolipoprotein A-1, and estimated glomerular filtration rate (GFR) compared with patients without cardiovascular events. Conversely, LDL-C, non-HDL-C, apolipoprotein B, remnantlike particle cholesterol, and high-sensitivity C-reactive protein (hs-CRP) levels were similar between the two groups. A Kaplan-Meyer event-free survival curve demonstrated that patients with sdLDL-C≥35 mg/dL (median level) had significantly poorer prognosis compared with those with lower sdLDL-C levels, while patients with LDL-C ≥100 mg/dL had a non-significantly lower survival rate.
Conclusion:
These results confirm that sdLDL-C is a very promising biomarker to predict future cardiovascular events in the secondary prevention of stable CAD.
Related Concept Videos
01:26Coronary Artery Disease IV: Preventive Measures
01:25Blood Studies for Cardiovascular System III: Serum Lipid Profile
Serum lipids are fats and fatty substances in the blood and are crucial for various bodily functions, including energy storage, cellular structure, and hormone production. Serum lipids consist of cholesterol, triglycerides, and phospholipids.
Cholesterol is a soft, fat-like substance found in all body cells. It is crucial for producing hormones, vitamin D, and substances that aid...
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:30Coronary Artery Disease I: Introduction
01:26Atherosclerosis III: Management
01:26Coronary Artery Disease II: Pathophysiology