Calculated small-dense and large-buoyant low-density lipoprotein-cholesterol and their ratio in predicting coronary artery disease risk: A cohort study in Thailand

Abstract

Objectives: Calculated, small dense low-density lipoprotein cholesterol (CsdLDL-C), derived using the Sampson equation, has been proposed as a screening tool for atherosclerotic cardiovascular disease risk. The current study investigated the utility of CsdLDL-C and calculated large buoyant low-density lipoprotein cholesterol (ClbLDL-C) for coronary artery disease (CAD) risk assessment in a Thai population. Methods: This study included 6448 participants without prior CAD from the Electricity Generating Authority of Thailand (EGAT) prospective cohort (2007–2009). CsdLDL-C and ClbLDL-C were estimated from standard lipid panel measurements. Associations with CAD risk were evaluated using Kaplan–Meier survival analysis and Cox proportional hazards models. Results: Over a mean follow-up period of 10.24 ± 1.01 years, 262 (4.06 %) participants experienced CAD events. At the optimal cutoffs, high CsdLDL-C [>1.08 mmol/L (41.85 mg/dL)] was significantly associated with incident CAD events (HR = 1.57; 95 % CI = 1.22–2.02), whereas high ClbLDL-C [>2.52 mmol/L (97.59 mg/dL)] was inversely associated with incident CAD events (HR = 0.72; 95 % CI = 0.56-0.92). The CsdLDL-C/ClbLDL-C ratio exhibited the strongest association (HR = 2.02; 95 % CI = 1.58–2.60) among all lipid parameters. When individually added to the pooled cohort risk equation, CsdLDL-C and the CsdLDL-C/ClbLDL-C ratio remained significant predictors of new-onset CAD. They also demonstrated good discriminatory power (P < 0.004). Conclusion: CsdLDL-C and ClbLDL-C, derived using the Sampson equation, were significantly associated with CAD risk in the opposite direction. Their ratio had greater predictive effectiveness. Incorporating CsdLDL-C and the CsdLDL-C/ClbLDL-C ratio into cardiovascular risk assessment models may improve early identification of at-risk individuals.