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A High Level of Calculated Small Dense Low-Density Lipoprotein Cholesterol Is an Independent Risk Factor for the
Hiroki Aida1, Marenao Tanaka1, Tatsuya Sato1,2
1Division of Cardiovascular-Kidney-Metabolic Medicine, Department of Internal Medicine, Sapporo Medical University School of Medicine.
Background:
Beyond low-density lipoprotein cholesterol (LDL-C), small dense LDL-C (sdLDL-C) is a residual risk factor for atherosclerotic cardiovascular disease. However, whether sdLDL-C levels can predict the development of chronic kidney disease remains unclear.
Methods And Results:
We investigated the association between the sdLDL-C level calculated using Sampson's equation and the progression of renal impairment in 16,814 Japanese individuals (10,806 men, 6,008 women; mean age: 47 years) who underwent annual health checkups. Participants were divided into 4 groups according to high (H) or low (L) sdLDL-C and LDL-C levels. Over a 10-year follow-up period, 2,533 participants progressed renal impairment, defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2or positive for urine protein. Cox proportional hazards model with a restricted cubic spline after adjustment for confounders showed a gradual increase in the hazard ratio (HR) for renal impairment with high levels of sdLDL-C. Compared with the L-sdLDL-C/L-LDL-C group (reference) the adjusted HRs for renal impairment were significantly higher in the H-sdLDL-C/H-LDL-C and H-sdLDL-C/L-LDL-C groups (1.13 [95% confidence interval 1.03-1.25] and 1.15 [95% confidence interval 1.03-1.29], respectively). The addition of a high sdLDL-C level (≥35.7 mg/dL) to traditional risk factors significantly improved the discriminatory capacity for renal impairment.
Conclusions:
A high calculated sdLDL-C level was an independent predictor for the progression of renal impairment regardless of LDL-C level in a general Japanese population.
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