Key result
Higher small dense LDL linked to ~44% higher MI risk in dialysis patients.
Why the study?
The prognostic relevance of estimated small dense low-density lipoprotein cholesterol (E-sdLDL-C) for myocardial infarction in patients undergoing dialysis remains uncertain.
Does higher estimated small dense low-density lipoprotein cholesterol (E-sdLDL-C) predict incident myocardial infarction in adults receiving long-term dialysis?
Cohort (n=21,671)
Yes
Does higher estimated small dense low-density lipoprotein cholesterol (E-sdLDL-C) predict incident myocardial infarction in adults receiving long-term dialysis?
Hazard Ratio: 1.44 (95% CI 1.15–1.8)
Higher estimated small dense LDL-C is associated with an increased risk of incident myocardial infarction in ESKD patients on long-term dialysis, though it did not significantly improve risk prediction models compared to standard LDL-C or non-HDL-C.
Background Small dense low-density lipoprotein cholesterol (sdLDL-C) is an atherogenic LDL subfraction that may reflect lipid-related coronary risk beyond conventional cholesterol levels. Estimated sdLDL-C (E-sdLDL-C) is calculated from a standard lipid panel, but its prognostic relevance for myocardial infarction in patients undergoing dialysis remains uncertain.Methods This nationwide cohort study included 21,671 adults with end-stage kidney disease (ESKD) receiving long-term dialysis who underwent health screening in 2009–2017. E-sdLDL-C was calculated from fasting lipid profiles and categorised into quartiles. Incident myocardial infarction and ischemic stroke were the primary and secondary outcomes, respectively, assessed through December 2022.Results During 166,428 person-years, 993 myocardial infarctions occurred, with 9,426 deaths before myocardial infarction. Fully adjusted hazard ratios for myocardial infarction in Quartiles 2–4 versus Quartile 1 were 1.24 (95% CI, 1.01–1.52), 1.61 (1.32–1.96), and 1.44 (1.15–1.80), respectively. The association remained significant after accounting for competing mortality. For ischemic stroke, 1,249 events and 9,254 competing deaths occurred during 165,727 person-years, with no significant association with E-sdLDL-C after full adjustment. Adding E-sdLDL-C increased the C-index for myocardial infarction from 0.716 to 0.726 (Δ = 0.010), without significant differences from models including LDL-C (0.725; p = 0.453) or non-HDL-C (0.727; p = 0.264).Conclusion Among patients undergoing long-term dialysis, E-sdLDL-C was associated with incident myocardial infarction after multivariable adjustment, whereas no significant association was observed with ischemic stroke. These findings support the potential relevance of E-sdLDL-C for myocardial infarction risk assessment in patients with ESKD, although its clinical utility requires further validation.
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Kim et al. (2026) conducted a cohort in End-stage kidney disease (ESKD) receiving long-term dialysis (n=21,671). Estimated small dense low-density lipoprotein cholesterol (E-sdLDL-C) vs. Lowest quartile (Quartile 1) of E-sdLDL-C was evaluated on Incident myocardial infarction (HR 1.44, 95% CI 1.15-1.80). Among adults undergoing long-term dialysis, higher levels of estimated small dense LDL cholesterol were associated with increased risk of incident myocardial infarction (HR for Quartile 4 vs 1, 1.44; 95% CI 1.15-1.80).
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