{
  "abstract": "Objectives Premature acute coronary syndrome (PACS) presents with a poor prognosis and significant risks. This study aimed to investigate the association between small-dense low-density lipoprotein cholesterol (sdLDL-C) levels and the severity of coronary lesions, as well as its potential role in risk stratification for PACS patients with multivessel disease (MVD).Design Retrospective cross-sectional study.Setting First Affiliated Hospital of Xinjiang Medical University in China, between May 2022 and November 2023.Participants 900 PACS patients with MVD confirmed by coronary angiography (CAG) and 600 age-matched and sex-matched controls with normal CAG results.Methods Patients with PACS and MVD were stratified by the Global Registry of Acute Coronary Events (GRACE) score, and sdLDL-C levels were compared among the different GRACE score groups. The association between sdLDL-C and the GRACE score was evaluated using Pearson’s correlation analysis. Multivariate logistic regression analysis was employed to identify factors associated with PACS and MVD. The discriminatory ability of sdLDL-C for PACS with MVD was assessed using receiver operating characteristic (ROC) curve analysis. Restriction cubic spline (RCS) analysis was used to examine the potential nonlinear association between sdLDL-C levels and the high-risk groups of PACS with MVD.Results Patients with PACS and MVD exhibited significantly higher sdLDL-C levels compared with control group (p<0.0001). Multivariate logistic regression analysis identified elevated sdLDL-C as an independent factor associated with PACS and MVD (OR =1.327; 95% CI =1.258 to 1.400; p<0.0001). The area under the curve (AUC) for sdLDL-C in discriminating PACS with MVD was 0.846 (95% CI=0.826 to 0.866, with a sensitivity of 94.7% and specificity of 58.0%). Furthermore, sdLDL-C levels were significantly higher in the high-risk group than in the low-moderate risk groups (p<0.0001). A strong positive association was observed between sdLDL-C levels and the GRACE score (r=0.644; p<0.0001). The AUC of sdLDL-C for discriminating high-risk cases of PACS with MVD was 0.841 (95% CI=0.815 to 0.867, with sensitivity of 94.3% and specificity of 62.3%). The RCS curve revealed a significant nonlinear association between increasing sdLDL-C levels and the high-risk groups of PACS with MVD (p value for nonlinearity=0.006).Conclusions Elevated sdLDL-C levels demonstrated a significant association with the risk of PACS and MVD. These findings indicate sdLDL-C may serve as a potential biomarker for risk stratification in this high-risk population. However, causal inferences require validation in prospective studies.Trial registration number ChiCTR2300074166",
  "authors": [
    {
      "affiliations": [
        "Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China",
        "Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China"
      ],
      "name": "Munawaer Keremu"
    },
    {
      "affiliations": [
        "Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China",
        "Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China",
        "Sinopharm Dongfeng General Hospital (Hubei Clinical Research Center of Hypertension), Hubei University of Medicine, Shiyan, Hubei, China"
      ],
      "name": "Xiao-Lei Li"
    },
    {
      "affiliations": [
        "Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China",
        "Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China"
      ],
      "name": "Xiao-Mei Li"
    },
    {
      "affiliations": [
        "Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China",
        "Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China"
      ],
      "name": "Adila Wulamu"
    },
    {
      "affiliations": [
        "Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China",
        "Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China"
      ],
      "name": "Shu-Ying Ding"
    },
    {
      "affiliations": [
        "Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China",
        "Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China"
      ],
      "name": "Aibibanmu Aizezi"
    },
    {
      "affiliations": [
        "Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China",
        "Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China"
      ],
      "name": "Yan-Peng Li"
    },
    {
      "affiliations": [
        "Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China",
        "Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China"
      ],
      "name": "Fen Liu"
    },
    {
      "affiliations": [
        "Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China",
        "Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China"
      ],
      "name": "Xia Li"
    },
    {
      "affiliations": [
        "Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China",
        "Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China"
      ],
      "name": "Yu-Nan Wang"
    },
    {
      "affiliations": [
        "Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China",
        "Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China"
      ],
      "name": "Dilare Adi"
    },
    {
      "affiliations": [
        "Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China",
        "Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China"
      ],
      "name": "Yi-Tong Ma"
    }
  ],
  "title": "Association of small dense low-density lipoprotein cholesterol with cardiovascular risk in premature acute coronary syndrome and multivessel disease: a single-centre retrospective cross-sectional study",
  "uid": "ce770668-25af-55af-a2a2-c9e1e4337031"
}