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Small Dense Low-Density Lipoprotein Cholesterol: A Residual Risk for Rapid Progression of Non-Culprit Coronary Lesion
Teruo Sekimoto1, Shinji Koba1, Hiroyoshi Mori2
1Division of Cardiology, Department of Medicine, Showa University School of Medicine.
Insights
Elevated small dense low-density lipoprotein cholesterol (sd-LDL-c) after acute coronary syndrome predicts lesion progression and cardiovascular events. Aggressive reduction of sd-LDL-c may be necessary to prevent future cardiac events.
Area of Science:
- Cardiology
- Lipid Metabolism
- Atherosclerosis Research
Background:
- Acute coronary syndrome (ACS) patients are at high risk for recurrent cardiovascular events.
- Non-culprit coronary artery lesions can progress rapidly after ACS, contributing to adverse outcomes.
- Small dense low-density lipoprotein cholesterol (sd-LDL-c) is increasingly recognized as a significant cardiovascular risk factor.
Purpose of the Study:
- To investigate the association between sd-LDL-c levels and rapid progression (RP) of non-culprit coronary artery lesions.
- To determine if sd-LDL-c levels predict cardiovascular events (CE) following ACS.
- To evaluate the role of on-treatment sd-LDL-c as a residual risk marker.
Main Methods:
- A cohort of 142 ACS patients undergoing percutaneous coronary intervention were followed for 10 months.
- sd-LDL-c levels were measured on admission and at follow-up angiography.
- RP was defined by progression of existing stenosis or new lesions; CEs included cardiac death, myocardial infarction, stroke, or revascularization.
Main Results:
- Patients with RP showed significantly higher follow-up levels of sd-LDL-c, triglycerides, remnant lipoprotein cholesterol (RL-c), and apoC3.
- An sd-LDL-c level ≥ 20.9 mg/dL was identified as a predictor of RP.
- Elevated on-treatment sd-LDL-c (≥ 20.9 mg/dL) was significantly associated with incident CEs over a median follow-up of 31 months.
Conclusions:
- On-treatment sd-LDL-c levels are significantly associated with the rapid progression of non-culprit lesions and subsequent cardiovascular events in ACS patients.
- Elevated sd-LDL-c represents a residual cardiovascular risk after ACS treatment.
- Aggressive reduction of sd-LDL-c may be a crucial strategy for preventing cardiovascular events in this high-risk population.
Aim:
This study investigated whether the small dense low-density lipoprotein cholesterol (sd-LDL-c) level is associated with the rapid progression (RP) of non-culprit coronary artery lesions and cardiovascular events (CE) after acute coronary syndrome (ACS).
Methods:
In 142 consecutive patients with ACS who underwent primary percutaneous coronary intervention for the culprit lesion, the sd-LDL-c level was measured using a direct homogeneous assay on admission for ACS and at the 10-month follow-up coronary angiography. RP was defined as a progression of any pre-existing coronary stenosis and/or stenosis development in the initially normal coronary artery. CEs were defined as cardiac death, myocardial infarction, stroke, or coronary revascularization.
Results:
Patients were divided into two groups based on the presence (n=29) or absence (n=113) of RP after 10 months. The LDL-c and sd-LDL-c levels at baseline were equivalent in both the groups. However, the sd-LDL-c, triglyceride, remnant lipoprotein cholesterol (RL-c), and apoC3 levels at follow-up were significantly higher in the RP group than in the non-RP group. The optimal threshold values of sd-LDL-c, triglyceride, RL-c, and apoC3 for predicting RP according to receiver operating characteristics analysis were 20.9, 113, 5.5, and 9.7 mg/dL, respectively. Only the sd-LDL-c level (≥ 20.9 mg/dL) was significantly associated with incident CEs at 31±17 months (log-rank: 4.123, p=0.043).
Conclusions:
The sd-LDL-c level on treatment was significantly associated with RP of non-culprit lesions, resulting in CEs in ACS patients. On-treatment sd-LDL-c is a residual risk and aggressive reduction of sd-LDL-c might be needed to prevent CEs.
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