Association of sdLDL-C/LDL-C ratio with atherosclerotic cardiovascular disease: a case-control study

Background Low-density lipoprotein cholesterol (LDL-C) and small dense low-density lipoprotein cholesterol (sdLDL-C) are key drivers of atherosclerotic cardiovascular disease (ASCVD) risk. This study aims to investigate the correlation between sdLDL-C/LDL-C ratio and ASCVD to provide new ideas for accurate prediction of ASCVD and identifying high-risk groups. Methods The data were derived from patients who visited the Affiliated Hospital of Inner Mongolia Medical University from January 2019 to July 2023. The relationship between the sdLDL-C/LDL-C ratio and the odds of ASCVD was analyzed using univariate and multivariate logistic regression analysis. Subgroup analysis investigates the potential effects of age, sex, hypertension disease heterogeneity, and the relationship between ASCVD. Results The study included 8924 subjects with an average age of (59 +/- 11) years. Multivariate logistic regression analysis revealed that compared to the lowest quartile of sdLDL-C/LDL-C ratio, the odds of ASCVD increased by 1.39, 3.48, and 9.34 times in quartile groups 2, 3, and 4, respectively (OR values: 2.39 [95% CI 1.91-2.99], 4.48[95% CI 3.59-5.60], 10.34 [95% CI 8.08-13.22]; P < 0.001). This increasing trend was also observed in stratified analyses by age, hypertension and sex. Conclusions An elevated sdLDL-C/LDL-C ratio is associated with an increased odds of ASCVD. The ratio's predictive ability for ASCVD occurrence surpasses that of sdLDL-C alone.