Key result
Male sex was associated with higher prevalence of LDL-C/sdLDL-C discordance than female sex (28.2% vs. 9.6%; OR 3.71, 95% CI 2.62-5.26, P<0.001) among adults with LDL-C <140 mg/dL.
Why the study?
LDL-C alone may not fully capture residual atherogenic lipoprotein burden, and elevated small dense LDL-C may be overlooked when LDL-C is not elevated. Whether LDL-C/sdLDL-C discordance differs by sex across triglyceride strata remained unclear.
Does the prevalence of LDL-C/sdLDL-C discordance (sdLDL-C ≥35 mg/dL despite LDL-C <140 mg/dL) differ between men and women overall and across triglyceride strata in Japanese adults?
Cross-Sectional (n=1,879)
No
Does the prevalence of LDL-C/sdLDL-C discordance (sdLDL-C ≥35 mg/dL despite LDL-C <140 mg/dL) differ between men and women overall and across triglyceride strata in Japanese adults?
Among Japanese adults with non-elevated LDL-C (<140 mg/dL), elevated small dense LDL-C (≥35 mg/dL) is nearly three times more common in men than in women—even at normal triglyceride levels—and identifies an adverse ApoB-rich, oxidatively modified atherogenic lipid phenotype overlooked by LDL-C screening alone.
Answers are grounded in this paper and cite their sources.
Men with non-elevated LDL-C show higher discordance even at low TG; leaves open whether sdLDL-C refines sex-specific risk stratification.
Background: Low-density lipoprotein cholesterol (LDL-C) remains central to lipid-based cardiovascular risk assessment, but LDL-C alone may not fully capture residual atherogenic lipoprotein burden. Small dense LDL cholesterol (sdLDL-C) is influenced by LDL-C and triglyceride (TG)-rich lipoprotein metabolism, and elevated sdLDL-C may be overlooked when LDL-C is not elevated. Whether LDL-C/sdLDL-C discordance differs by sex across TG strata remains unclear. Methods: This cross-sectional study included 1879 Japanese adults undergoing annual health check-ups in 2020. The primary analysis included participants with LDL-C <140 mg/dL. Discordance was defined as sdLDL-C ≥35 mg/dL. Discordance prevalence was compared between men and women overall and across TG strata. Apolipoprotein B (ApoB), malondialdehyde-modified LDL (MDA-LDL), high-density lipoprotein 2 cholesterol (HDL2-C), high-density lipoprotein 3 cholesterol (HDL3-C), the HDL2-C/HDL3-C ratio, and high-molecular-weight adiponectin (HMW-adiponectin) were compared by discordance status. Results: Among participants with LDL-C <140 mg/dL, discordance was more frequent in men than in women [259/917 (28.2%) vs. 42/438 (9.6%), P < 0.001]. This sex difference persisted at TG < 150 mg/dL [16.0% vs. 4.2%, P < 0.001] and TG < 100 mg/dL [7.5% vs. 2.4%, P = 0.0015], but not at TG ≥ 150 mg/dL [74.1% vs. 71.4%, P = 0.835]. Discordant participants had higher ApoB and MDA-LDL and lower HDL2-C, HDL2-C/HDL3-C ratio, and HMW-adiponectin. Conclusions: LDL-C/sdLDL-C discordance was more frequent in men, particularly in lower TG strata, and was accompanied by an adverse atherogenic lipid profile.
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Kengo Moriyama (2026) conducted a cross-sectional in Non-elevated LDL-C (<140 mg/dL) evaluated for LDL-C/sdLDL-C discordance (n=1,879). Male sex vs. Female sex was evaluated on Prevalence of LDL-C/sdLDL-C discordance (defined as sdLDL-C ≥35 mg/dL among participants with LDL-C <140 mg/dL) (OR 3.71, 95% CI 2.62-5.26, p=<0.001). Male sex was associated with higher prevalence of LDL-C/sdLDL-C discordance than female sex (28.2% vs. 9.6%; OR 3.71, 95% CI 2.62-5.26, P<0.001) among adults with LDL-C <140 mg/dL.
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