{"id":"43f26e482fc1","type":"article","url":"https://hartvaat.nl/2026/12/01/geschat-sdldl-c-voorspelt-hartinfarct-bij-dialysepatienten/","title":"Geschat sdLDL-C voorspelt hartinfarct bij dialysepatiënten","title_en":"Estimated small dense low-density lipoprotein cholesterol and incident myocardial infarction in patients undergoing dialysis: a nationwide cohort study.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":[],"journal":"Annals of medicine","doi":"10.1080/07853890.2026.2745096","source_url":"https://doi.org/10.1080/07853890.2026.2745096","authors":["Byung Sik Kim","Hyun-Jin Kim","Jiyeong Kim","Nayeon Choi","Jeong-Hun Shin"],"significance":5,"published":"2026-10-16","source_date":"2026-12-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"In a nationwide cohort of 21,671 patients on long-term dialysis, higher estimated small dense LDL cholesterol (E-sdLDL-C) was significantly associated with an increased risk of incident myocardial infarction, independent of competing mortality. Adding E-sdLDL-C to risk models yielded a marginal improvement in discrimination (C-index 0.716 to 0.726) but did not significantly outperform standard LDL-C or non-HDL-C. While sdLDL-C shows promise for refining cardiovascular risk assessment in end-stage kidney disease, its incremental clinical utility for guiding lipid-lowering therapy requires further validation.","created":"2026-10-10T00:52:09Z","updated":"2026-10-10T00:52:09Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"In een landelijk cohort van 21.671 dialysepatiënten bleek een verhoogd geschat small dense LDL-cholesterol (E-sdLDL-C) significant geassocieerd te staan met een hoger risico op incident hartinfarct, zelfs na correctie voor competitief overlijden. Het toevoegen van E-sdLDL-C aan risicomodellen verbeterde de discriminatie licht (C-index 0,716 naar 0,726), maar presteerde niet significant beter dan standaard LDL-C of non-HDL-C. Deze bevindingen ondersteunen de potentiële waarde van sdLDL-C voor cardiovasculaire risicoschatting bij nierfalen, maar de toegevoegde klinische meerwaarde voor therapeutische besluitvorming blijft onzeker.","abstract_original":"BACKGROUND: Small dense low-density lipoprotein cholesterol (sdLDL-C) is an atherogenic LDL subfraction that may reflect lipid-related coronary risk beyond conventional cholesterol levels. Estimated sdLDL-C (E-sdLDL-C) is calculated from a standard lipid panel, but its prognostic relevance for myocardial infarction in patients undergoing dialysis remains uncertain. METHODS: This nationwide cohort study included 21,671 adults with end-stage kidney disease (ESKD) receiving long-term dialysis who underwent health screening in 2009-2017. E-sdLDL-C was calculated from fasting lipid profiles and categorised into quartiles. Incident myocardial infarction and ischemic stroke were the primary and secondary outcomes, respectively, assessed through December 2022. RESULTS: During 166,428 person-years, 993 myocardial infarctions occurred, with 9,426 deaths before myocardial infarction. Fully adjusted hazard ratios for myocardial infarction in Quartiles 2-4 versus Quartile 1 were 1.24 (95% CI, 1.01-1.52), 1.61 (1.32-1.96), and 1.44 (1.15-1.80), respectively. The association remained significant after accounting for competing mortality. For ischemic stroke, 1,249 events and 9,254 competing deaths occurred during 165,727 person-years, with no significant association with E-sdLDL-C after full adjustment. Adding E-sdLDL-C increased the C-index for myocardial infarction from 0.716 to 0.726 (Δ = 0.010), without significant differences from models including LDL-C (0.725; p = 0.453) or non-HDL-C (0.727; p = 0.264). CONCLUSION: Among patients undergoing long-term dialysis, E-sdLDL-C was associated with incident myocardial infarction after multivariable adjustment, whereas no significant association was observed with ischemic stroke. These findings support the potential relevance of E-sdLDL-C for myocardial infarction risk assessment in patients with ESKD, although its clinical utility requires further validation."}