Key result
Higher estimated small dense LDL-C is linked to ~35% greater incident IFG risk per SD.
Why the study?
Is higher estimated small dense LDL cholesterol associated with an increased risk of incident impaired fasting glucose in Chinese adults?
Cohort (n=101,084)
Yes
Is higher estimated small dense LDL cholesterol associated with an increased risk of incident impaired fasting glucose in Chinese adults?
Hazard Ratio: 1.35 (95% CI 1.31–1.39)
Absolute Event Rate: 18% vs 7.71%
Elevated estimated small dense LDL cholesterol, derived from routine lipid parameters, is significantly associated with an increased risk of incident impaired fasting glucose and may serve as a practical biomarker for early identification of high-risk individuals.
Diabetes poses a growing global public health burden, with impaired fasting glucose (IFG) representing a key prediabetic stage. Small dense low-density lipoprotein cholesterol (sdLDL-C) is an atherogenic lipid subfraction implicated in dysglycemia pathogenesis. Compared to the direct measurement of sdLDL-C, estimated small dense LDL cholesterol (EsdLDL-C) can be calculated using low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG) through a formula, making it highly suitable for large-scale initial screening. However, evidence regarding its association with the risk of IFG in Chinese populations remains relatively limited. This study aims to explore the relationship between EsdLDL-C and the risk of incident IFG in Chinese adults. The study analyzed data from 101084 Chinese adults with normal fasting glucose, derived from a multicenter health screening database. The exposure was EsdLDL-C. The outcome was new-onset IFG. The relationship between EsdLDL-C and IFG risk was examined using multivariable Cox proportional hazards regression. Restricted cubic splines (RCS) explored nonlinearity, and subgroup analyses assessed consistency. Over a median follow-up of 3.0 years, 12.41% of participants developed IFG. The absolute incidence of IFG increased markedly from 7.71% in Q1 to 18.00% in Q4. Higher EsdLDL-C levels were significantly associated with increased IFG risk (per 1-SD increase: HR = 1.35, 95% CI: 1.31 – 1.39 in the fully adjusted model). A dose-response relationship was observed across quartiles. RCS analysis revealed a statistically nonlinear association with an inflection point at EsdLDL-C = 24.48 (HR 1.026 vs. 1.031). Given the similar HRs, this threshold is considered an exploratory finding rather than a definitive clinical cut-off. Results remained consistent in sensitivity and subgroup analyses. Elevated EsdLDL-C, as a derived lipid marker, is significantly associated with an elevated risk of incident IFG in Chinese adults, exhibiting a continuous dose-response relationship, with statistical nonlinearity suggesting an exploratory risk gradient. EsdLDL-C, derived from routine lipid parameters, may serve as a practical biomarker for early identification of high-risk individuals, informing targeted diabetes prevention strategies. Not applicable.
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Yang et al. (2026) conducted a cohort in Normal fasting glucose (n=101,084). Estimated small dense LDL cholesterol (EsdLDL-C) vs. Lower EsdLDL-C levels (Q1) was evaluated on New-onset impaired fasting glucose (IFG) (HR 1.35, 95% CI 1.31-1.39). Higher estimated small dense LDL cholesterol levels were significantly associated with an increased risk of incident impaired fasting glucose (HR 1.35 per 1-SD increase; 95% CI 1.31-1.39).
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