Background This study investigated whether directly measured small dense low-density lipoprotein cholesterol (D-sdLDL-C) can predict long-term coronary artery disease (CAD) events compared with low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), apolipoprotein B (apoB), and estimated small dense low-density lipoprotein cholesterol (E-sdLDL-C) determined by the Sampson equation in patients with stable CAD. Methods D-sdLDL-C measured at Showa University between 2010 and 2022, and E-sdLDL-C were evaluated in 790 male and 244 female patients with stable CAD. CAD events, defined as sudden cardiac death, onset of acute coronary syndrome, and/or need for coronary revascularization, were monitored for 12 years. Cutoff lipid levels were determined by receiver operating characteristic curves. Results CAD events were observed in 238 male and 67 female patients. The Kaplan–Meier event-free survival curves showed that patients with D-sdLDL-C ≥32.1 mg/dL (0.83 mmol/L) had an increased risk for CAD events (P = 0.007), whereas risk in patients with E-sdLDL-C ≥36.2 mg/dL (0.94 mmol/L) was not increased. In the group with high D-sdLDL-C, the multivariable-adjusted hazard ratio (HR) was 1.47 (95% CI, 1.15–1.89), and it remained significant after adjustment for LDL-C, non-HDL-C, or apoB and in patients treated with statins. HRs for high LDL-C, non-HDL-C, or apoB were not statistically significant after adjustment for high D-sdLDL-C. Higher D-sdLDL-C was associated with enhanced risk of high LDL-C, non-HDL-C, and apoB (HR 1.73; 95% CI, 1.27–2.37). Conclusions Higher D-sdLDL-C can predict long-term recurrence of CAD in stable CAD patients independently of apoB and non-HDL-C. D-sdLDL-C is an independent risk enhancer for secondary CAD prevention, whereas E-sdLDL-C is not. UMIN-CTR Clinical Trial Number: UMIN000027504

中文翻译：

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直接测量小而致密的低密度脂蛋白胆固醇对稳定型冠状动脉疾病患者长期二级预防的影响


背景 本研究调查了与低密度脂蛋白胆固醇 （LDL-C）、非高密度脂蛋白胆固醇 （non-HDL-C）、载脂蛋白 B （apoB） 相比，直接测量的小致密低密度脂蛋白胆固醇 （D-sdLDL-C） 是否可以预测长期冠状动脉疾病 （CAD） 事件，并通过 Sampson 方程确定估计的小致密低密度脂蛋白胆固醇 （E-sdLDL-C） 在稳定型 CAD 患者中。方法 昭和测量的 D-sdLDL-C2010 年至 2022 年期间的大学，并在 790 名男性和 244 名女性稳定 CAD 患者中评估了 E-sdLDL-C。CAD 事件，定义为心源性猝死、急性冠脉综合征发作和/或需要冠状动脉血运重建，监测了 12 年。临界脂质水平由受试者工作特征曲线确定。结果 在 238 例男性和 67 例女性患者中观察到 CAD 事件。Kaplan-Meier 无事件生存曲线显示，D-sdLDL-C ≥32.1 mg/dL （0.83 mmol/L） 患者发生 CAD 事件的风险增加 （P = 0.007），而 E-sdLDL-C ≥36.2 mg/dL （0.94 mmol/L） 患者的风险没有增加。在高 D-sdLDL-C 组中，多变量调整风险比 （HR） 为 1.47 （95% CI，1.15-1.89），在调整 LDL-C、非 HDL-C 或 apoB 后以及接受他汀类药物治疗的患者中仍然显著。在调整高 D-sdLDL-C 后，高 LDL-C、非 HDL-C 或 apoB 的 HR 无统计学意义。较高的 D-sdLDL-C 与高 LDL-C、非 HDL-C 和 apoB 的风险增加相关 （HR 1.73;95% CI，1.27-2.37）。结论 较高的 D-sdLDL-C 可以独立于 apoB 和非 HDL-C 预测稳定型 CAD 患者 CAD 的长期复发。 D-sdLDL-C 是二级 CAD 预防的独立风险增强剂，而 E-sdLDL-C 则不是。UMIN-CTR 临床试验编号：UMIN000027504