Study on Small Dense LDL Cholesterol and Ischemic Stroke

Researchers have found in a new study that higher small dense low-density lipoprotein cholesterol levels were robustly associated with increased risk of ischemic stroke. The study has been published in the journal Annals of Neurology.

For decades, it has been suggested that small dense low-density lipoprotein (sdLDL) may be particularly atherogenic. High levels of small dense low-density lipoprotein are associated with an increased risk of ischemic heart disease; however, the association of small dense low-density lipoprotein (LDL) with ischemic stroke has not been explored in a large prospective study on the general population. We tested the hypothesis that high small dense low-density lipoprotein (LDL) cholesterol levels are associated with an increased risk of ischemic stroke.

Study Details

This prospective study included 38,319 individuals from the Copenhagen General Population Study with fresh sample measurements of sdLDL cholesterol. Median follow-up time was 3.1 years. We observed 302 and 74 ischemic and haemorrhagic strokes from baseline in 2013-2017 to end of follow-up in 2018. They included estimates for large buoyant LDL cholesterol and total LDL cholesterol for comparison.

Results

• Higher levels of sdLDL cholesterol were log-linearly associated with increased risk of ischemic stroke.
• Compared to individuals with sdLDL cholesterol in the lowest tertile, the multivariable adjusted hazard ratio for ischemic stroke was 1.79 for the highest tertile.
• Multivariable adjusted hazard ratios for ischemic stroke per 1 mmol/L (38.7 mg/dL) higher levels were 1.69 for sdLDL cholesterol, 0.95 (0.78-1.16) for large buoyant LDL cholesterol, and 1.08 (0.93-1.25) for total LDL cholesterol.
• Hazard ratios were similar when further adjusting for BMI and diabetes mellitus in the biological pathway in combination with related lipids and lipoproteins.

Higher small dense low-density lipoprotein (LDL) cholesterol levels were robustly associated with increased risk of ischemic stroke.

Reference

Balling, M., Nordestgaard, B.G., Varbo, A., Langsted, A., Kamstrup, P.R. and Afzal, S. (2023), Small dense LDL cholesterol and ischemic stroke. Ann Neurol. Accepted Author Manuscript. https://doi.org/10.1002/ana.26598