Estimated sdLDL-C predicts cardiovascular risk in Japanese adults
In over 1.8 million Japanese adults, the highest quartile of estimated sdLDL-C carried an ASCVD hazard ratio of 1.25 compared with the lowest.
Journal of Clinical Lipidology
In a study of 1,884,758 Japanese adults aged 40 to 74 years, higher estimated small dense low-density lipoprotein cholesterol was associated with an increased risk of atherosclerotic cardiovascular disease. Researchers analyzed health checkup records from the DeSC database between April 2014 and March 2023. They used the Sampson formula to calculate estimated sdLDL-C and tracked first hospitalizations for atherosclerotic cardiovascular disease via insurance claims data. Over the study period, participants experienced 22,596 incident events. After adjusting for age, sex, metabolic risk factors, and lipid-lowering medications, cardiovascular risk rose across estimated sdLDL-C quartiles, reaching a hazard ratio of 1.25 in the fourth quartile. The association persisted across sexes, age groups, and among participants with low LDL-C.
Why it matters
Atherosclerotic cardiovascular disease is a major driver of age-related illness and mortality. Using an equation to estimate atherogenic sdLDL-C from standard lipid panels may improve cardiovascular risk detection without requiring specialized tests.
Caveats
The observational design cannot establish causality, the findings reflect a Japanese health checkup cohort, and sdLDL-C was estimated mathematically rather than directly measured.
The paper
Keio University
Journal of Clinical Lipidology · 15 Sep 2026