Katajamäki Taina T, Koivula Marja-Kaisa, Salminen Marika J, Vahlberg Tero, Heikkilä Elisa T M, Viljanen Anna M, Löppönen Minna K, Isoaho Raimo E, Kivelä Sirkka-Liisa, Viitanen Matti, Viikari Jorma, Viikari Laura, Pulkki Kari J, Irjala Kerttu M
Faculty of Medicine, Department of Clinical Medicine, Unit of Clinical Chemistry, University of Turku 20521 Turku, Finland; Wellbeing Services County of Southwest Finland, Turku University Hospital, Laboratory Division, 20521 Turku, Finland.
HUS Diagnostic Center, Helsinki University Hospital, HUS Group, 00029 Helsinki, Finland; Clinical Chemistry and Hematology, Faculty of Medicine, University of Helsinki 00014 Helsinki, Finland.
Clin Biochem. 2025 Jun;137:110916. doi: 10.1016/j.clinbiochem.2025.110916. Epub 2025 Mar 17.
Small dense low-density lipoprotein (sdLDL) is atherogenic and associated with atherosclerotic cardiovascular diseases (ASCVD). The aim of this study was to perform the prospective evaluation of sdLDL-c in new ASCVD over 18 years of follow up, and to compare the association of sdLDL-c and conventional lipids and apolipoproteins with ASCVD in the elderly.
This prospective study included a total of 1770 subjects ≥ 64 years of age with an 18-year follow-up period. The determination of sdLDL-c was measured by a homogenous, selective enzymatic method. Levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c) and triglycerides (TG) were determined by enzymatic methods. Apolipoproteins, ApoA1 and ApoB, were analyzed by immunonephelometric methods. Low-density lipoprotein cholesterol (LDL-c) levels were calculated using the Friedewald formula.
According to Pearson's correlation coefficients, sdLDL-c concentration was positively correlated with LDL-c, nonHDL-c, TC and ApoB concentrations. During follow up, sdLDL-c was significantly associated with new ASCVD in men aged 64-76 years in both unadjusted and adjusted Cox regression models. The adjusted hazard ratio (95 % CI) for sdLDL-c was 1.61 (1.13-2.28). No significant associations between sdLDL-c and ASCVD were observed in men aged 77-97 years, nor in women aged 64-79 or 80-100 years.
Lipid and apolipoprotein concentrations of the elderly were high compared to the recommended target values. In addition, lipid and apolipoprotein baseline concentrations were not higher in the ASCVD group than in the control group. Our results indicated that sdLDL-c is as good a marker as ApoB and better than LDL-c.
小而密低密度脂蛋白（sdLDL）具有致动脉粥样硬化作用，并与动脉粥样硬化性心血管疾病（ASCVD）相关。本研究的目的是对新发生的ASCVD患者进行长达18年随访的sdLDL-c前瞻性评估，并比较老年人中sdLDL-c以及传统脂质和载脂蛋白与ASCVD的关联。
这项前瞻性研究共纳入1770名年龄≥64岁的受试者，随访期为18年。采用均相、选择性酶法测定sdLDL-c。采用酶法测定总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-c）和甘油三酯（TG）水平。采用免疫比浊法分析载脂蛋白ApoA1和ApoB。使用Friedewald公式计算低密度脂蛋白胆固醇（LDL-c）水平。
根据Pearson相关系数，sdLDL-c浓度与LDL-c、非HDL-c、TC和ApoB浓度呈正相关。在随访期间，在未调整和调整后的Cox回归模型中，sdLDL-c与64至76岁男性新发生的ASCVD显著相关。sdLDL-c的调整后风险比（95%CI）为1.61（1.13 - 2.28）。在77至97岁男性中，以及在64至79岁或80至100岁女性中，未观察到sdLDL-c与ASCVD之间存在显著关联。
与推荐的目标值相比，老年人的脂质和载脂蛋白浓度较高。此外，ASCVD组的脂质和载脂蛋白基线浓度并不高于对照组。我们的结果表明，sdLDL-c与ApoB一样是良好的标志物，且优于LDL-c。
