Blood concentrations of triglyceride-rich lipoprotein cholesterol (TRL-C) and small-dense low-density lipoprotein cholesterol (sdLDL-C) were found to be associated with the risk for cardiovascular disease, according to study results published in Journal of the American College of Cardiology.

In this prospective case-cohort study, 480 women with incident total cardiovascular disease and a subcohort of 496 control women matched on age and smoking status, were included. Women vs without with incident myocardial infarction, ischemic stroke, and peripheral artery disease had higher mean blood levels of TRL-C and sdLDL-C. Baseline concentrations of TRL-C and sdLDL-C were directly measured from patient blood samples. The occurrence of incident myocardial infarction, ischemic stroke, peripheral artery disease, and death from cardiovascular events were assessed by annual questionnaires.

After adjusting for cardiovascular disease risk factors, elevated levels of TRL-C (hazard ratio [HR], 1.87; 95% CI, 1.14-3.06; P =.013) and sdLDL-C (HR, 1.67; 95% CI, 0.95-1.94; P =.025) were found to be associated with an increased risk for total cardiovascular disease.

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Elevated levels of TRL-C (HR, 3.05; 95% CI, 1.46-6.39; P =.002) and sdLDL-C (HR, 3.71; 95% CI, 1.59-8.63; P <.001) were found to be strongly predictive of incident myocardial infarction. Baseline TRL-C, but not sdLDL-C, was also associated with an increased risk for peripheral artery disease (HR, 2.58; 95% CI, 1.18-5.63; P =.019).

Study limitations include a homogeneous cohort and a low prevalence of cardiovascular risk factors, which may limit the generalizability of results to other populations.

“Baseline levels of TRL-C and sdLDL-C measured in our study associated with future cardiovascular events differently despite similar correlations with traditional [cardiovascular] risk factors and traditional indexes of atherogenic dyslipidemia,” the study authors concluded. “Recommendations in future lipid guidelines to measure TRL-C when [apolipoprotein B] is within normal limits may help to identify subjects who are at persistent risk of future atherosclerotic events.”

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Disclosures: Funding for this study was partially provided by Denka-Seiken Co., Ltd. Several authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of disclosures.


Duran EK, Aday AW, Cook NR, Buring JE, Ridker PM, Pradhan AD. Triglyceride-rich lipoprotein cholesterol, small dense LDL cholesterol, and incident cardiovascular disease. J Am Coll Cardiol. 2020;75(17):2122‐2135. doi:10.1016/j.jacc.2020.02.059