2196-P: Association of E-sdLDL-C with Disease Progression and Mortality Risk among Individuals with CKM Syndrome

Introduction and Objective: This study aims to investigate the relationship between E-sdLDL-C, its discordance with LDL-C, and disease progression and mortality risk in adults with CKM syndrome. Methods: This study included adults at CKM stages 0-4 from NHANES (16,167 participants) and the CHARLS (8,494 participants). E-sdLDL-C was derived via Sampson’s equation, participants were grouped by E-sdLDL-C quartiles or by percentile divergences between E-sdLDL-C and LDL-C. Their associations with advanced CKM and mortality risk were assessed. Results: In NHANES, each SD increment in E-sdLDL-C was related to 23% higher risk of advanced CKM. Discordance in E-sdLDL-C/LDL-C levels significantly elevated the risk of advanced CKM, with the discordantly high group showing 2.66-fold increased risk. Results in CHARLS exhibited similar pattern.In CHARLS, both higher quartiles and discordantly higher E-sdLDL-C were associated with higher risk of incident CVD. A non-linear J-shaped relationship was found between E-sdLDL-C and all-cause mortality risk (P for nonlinear = 0.0106). Compared to the discordantly low E-sdLDL-C group, discordantly high E-sdLDL-C groups were associated with significantly higher risks of all-cause mortality (HR: 1.39, 95% CI: 1.19-1.63) and cardiovascular mortality (HR: 1.46, 95% CI: 1.08-1.98). Conclusion: Elevated E-sdLDL-C levels, particularly when discordant with LDL-C, reflects greater progression and mortality risks in CKM syndrome.