Impact of cumulative exposure and variations of small dense low-density lipoprotein cholesterol on the risk of incident cardiovascular diseases or stroke among middle-aged and old adults: Insights from CHARLS

Abstract

Objection: This study aims to investigate the associations of cumulative small dense low-density lipoprotein cholesterol (sdLDL-C) and changes with cardiovascular disease (CVD) or stroke risk in middle-aged and old adults.

Methods: Study data were extracted from the China Health and Retirement Longitudinal Study (CHARLS) database in 2011-2015. Associations of cumulative sdLDL-C, sdLDL-C change and sdLDL-C cluster (divided into 3 classes using the k-means cluster analysis) with risk of CVD or stroke were investigated utilizing multivariate logistic regression analysis, which evaluated through odds ratio (OR) with 95% confidence interval (CI).

Results: Follow-up until 2020, 662 of 4,353 participants had CVD or stroke. After adjusting for selected covariates, compared to lower cumulative levels of sdLDL-C (≤82.2), cumulative sdLDL-C levels of (99.4, 120] (OR=1.44, 95%CI: 1.12-1.86) and >120 (OR=1.41, 95%CI: 1.09-1.82) were associated with increased CVD/stroke odds, respectively. Compared to persistent low sdLDL-C change levels, persistent middle, persistent high and increasing sdLDL-C change were all linked to increased odds of CVD/stroke (all P<0.05). Participants with sdLDL-C level of Class 2 and Class 3 had increased odds of CVD/stroke risk, compared to those with sdLDL-C level of Class 1 (all P<0.05). Similar associations were observed between sdLDL-C and CVD risk but not with stroke.

Conclusions: High cumulative sdLDL-C levels and stably high sdLDL-C change was associated with an increased CVD/stroke risk. Timely monitoring sdLDL-C change may play a pivotal role in mitigating disease incidence, and however, targeted interventions and the underlying mechanisms of these associations need further clarification.