The following is a summary of “Small Dense Low-Density Lipoprotein Cholesterol and Coronary Artery Calcification in the Multi-Ethnic Study of Atherosclerosis,” published in the February 2024 issue of Cardiology by Rikhi et al.

Researchers conducted a retrospective study to investigate the association between elevated small dense-LDL-cholesterol (sd-LDL-C) levels and coronary artery calcium (CAC) as a predictor of atherosclerotic cardiovascular disease (CVD) risk.

They analyzed data from 4672 individuals with directly measured baseline sd-LDL-C and CAC from the Multi-Ethnic Study of Atherosclerosis. The participants had a mean (SD) age of 61.9 (10.4) years, with 52.5% women and 47.3% having baseline CAC (mean score >0). Multivariable general linear models and restricted cubic splines were utilized, with goodness of fit testing, to assess the relationship between sd-LDL-C and the presence of CAC (OR [95% CI]) were adjusted for demographics and cardiovascular risk factors, including estimated total LDL-C.

The result showed that higher quartiles of sd-LDL-C were linked to the presence of CAC, even after adjusting for total LDL-C. Compared to those in the lowest quartile of sd-LDL-C, individuals in Quartiles 2, 3, and 4 had increased odds of having baseline CAC (Quartile 2 OR: 1.24 [1.00, 1.53]; Quartile 3 OR: 1.51 [1.19, 1.93]; and Quartile 4 OR: 1.59 [1.17, 2.16]). Analysis using splines indicated a quadratic curvilinear relationship between continuous sd-LDL-C and CAC after adjusting for demographics and CVD risk factors (likelihood ratio test for quadratic vs first-order sd-LDL-C terms: P=0.015) but not after accounting for total LDL-C (likelihood ratio test for quadratic vs first-order terms: P=0.156).

Investigators concluded that higher levels of sd-LDL-C, independent of total LDL-C, are linked to coronary artery calcification. However, further research is needed to determine if direct sd-LDL-C measurement improves primary CVD risk assessment.

Source: academic.oup.com/eurjpc/advance-article-abstract/doi/10.1093/eurjpc/zwae049/7602452