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Association of the sdLDL-C/lbLDL-C ratio with heart failure beyond conventional LDL-C levels: a cross-sectional study

Xuyang Pan1, Fang Liu2, Wei Li1

  • 1Department of Cardiovascular Medicine, ShuYang Hospital of Traditional Chinese Medicine, Shu Yang, Jiangsu, China.

Frontiers in Cardiovascular Medicine
|August 1, 2026
PubMed

Insights

The ratio of small dense low-density lipoprotein cholesterol (sdLDL-C) to large buoyant LDL-C (lbLDL-C) is a key indicator for heart failure (HF) risk. This lipid profile characteristic, not conventional LDL-C, is significantly associated with HF.

Area of Science:

  • Cardiology
  • Biochemistry
  • Clinical Medicine

Background:

  • Heart failure (HF) is a leading global cause of death.
  • Blood lipid profiles are linked to the early risk of developing HF.

Purpose of the Study:

  • To investigate the association between blood lipid profiles and heart failure.
  • To identify specific lipid parameters indicative of HF risk.

Main Methods:

  • Included 584 newly diagnosed HF patients and 611 non-HF controls.
  • Quantified LDL-C subfractions (LDLC-1 to LDLC-7) using an LDL subfractions kit.
  • Performed multivariable logistic regression to identify independent correlates of HF.

Main Results:

  • Conventional LDL-C levels did not differ significantly between HF patients and controls.
  • HF patients exhibited significantly higher sdLDL-C levels and a lower lbLDL-C level.
  • The sdLDL-C/lbLDL-C ratio was identified as an independent factor associated with HF (OR = 2.199, P < 0.001).

Conclusions:

  • Lipoprotein subfraction characteristics, specifically the sdLDL-C/lbLDL-C ratio, are significantly associated with HF status.
  • This ratio may serve as a valuable biomarker for assessing HF risk and cardiac function.
Abstract

Keywords:
heart failurelbLDL-Cleft ventricular ejection fractionlipid profilesdLDL-C

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