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Published on: August 12, 2025
Relationship between small dense low density lipoprotein and cardiovascular events in patients with acute coronary
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, 100029, China.
Insights
Elevated small dense low-density lipoprotein cholesterol (sdLDL-C) significantly increases cardiovascular event risk in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). This finding aids in better risk stratification for these high-risk individuals.
Area of Science:
- Cardiology
- Biochemistry
- Preventive Medicine
Background:
- Residual cardiovascular risk persists despite effective LDL-C lowering therapies.
- Small dense LDL-C (sdLDL-C) is a known predictor of coronary heart disease (CHD) in stable patients.
- The role of sdLDL-C in acute coronary syndromes (ACS) post-percutaneous coronary intervention (PCI) remains underexplored.
Purpose of the Study:
- To investigate the association between sdLDL-C levels and cardiovascular (CV) events in ACS patients undergoing PCI.
- To determine if sdLDL-C provides additional risk prediction beyond LDL-C in this population.
Main Methods:
- A cohort of 6092 patients hospitalized with ACS undergoing PCI were enrolled.
- Patients were followed for 18 months, with CV events categorized as major adverse cardiovascular and cerebrovascular events (MACCE).
- Cox proportional hazards regression and subgroup analyses (by diabetes and LDL-C levels) were used to assess risk.
Main Results:
- The highest quartile of sdLDL-C was associated with a significantly increased risk of CV events (HR 1.92) compared to the lowest quartile.
- This increased risk was primarily driven by unplanned repeat revascularization.
- The association remained significant across subgroups defined by diabetes status and baseline LDL-C levels.
Conclusions:
- Elevated sdLDL-C is a significant predictor of CV events in Chinese patients with ACS undergoing PCI.
- sdLDL-C measurement offers added value for cardiovascular risk assessment in this patient cohort.
- Targeting sdLDL-C may represent a future strategy for reducing residual risk in ACS patients.
Background:
Residual risk remained significant despite effective low density lipoprotein cholesterol (LDL-C) lowering treatment. Small dense low density lipoprotein cholesterol (sdLDL-C) as part of LDL-C has been found to be predictor of coronary heart disease (CHD) and cardiovascular (CV) events in patients with stable CHD independently of LDL-C. However, to date, few studies have explored the role of sdLDL-C in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI). Accordingly, this study aimed to evaluate the association of sdLDL-C with CV events in patients with ACS undergoing PCI.
Methods:
Patients hospitalized with ACS undergoing PCI were enrolled and followed up for 18 months. The risk of sdLDL-C for CV events was compared according to sdLDL-C quartiles. The primary outcome was major cardiovascular and cerebrovascular adverse events (MACCE), which was the composite of all cause of death, nonfatal myocardial infarction (MI), nonfatal stroke or unplanned repeat revascularization. A Cox proportional hazards regression model was performed to estimate the risk of CV events. Subgroup analysis according to diabetes status and LDL-C were performed separately for MACCE.
Results:
A total of 6092 patients were included in the analysis (age: 60.2 ± 10.13 years, male: 75.3%, BMI: 25.9 ± 3.33 kg/m2, dyslipidemia: 74.1% and diabetes: 44.5%). During 18 months of follow-up, 320 (5.2%) incident CV events occurred. Compared to the lowest sdLDL-C quartile group, patients in the highest quartile had a greater risk of CV events after multivariable adjustment (HR 1.92; 95% CI 1.37-2.70). In addition, it was mainly due to the increase of unplanned repeat revascularization. In the subgroup analyses, significant association was observed regardless of level of LDL-C and diabetes status.
Conclusions:
Patients with elevated sdLDL-C have a higher risk of CV events in Chinese patients with ACS undergoing PCI, providing additional value for better risk assessment.
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