{"id":"https://openalex.org/W7223051670","doi":"https://doi.org/10.1136/bmjopen-2026-125031","title":"Small dense low-density lipoprotein cholesterol and risk of cardiovascular events in general adults: a systematic review and meta-analysis of prospective studies","display_name":"Small dense low-density lipoprotein cholesterol and risk of cardiovascular events in general adults: a systematic review and meta-analysis of prospective studies","publication_year":2026,"publication_date":"2026-10-01","ids":{"openalex":"https://openalex.org/W7223051670","doi":"https://doi.org/10.1136/bmjopen-2026-125031","pmid":"https://pubmed.ncbi.nlm.nih.gov/42901588","pmcid":"https://www.ncbi.nlm.nih.gov/pmc/articles/13684149"},"language":"en","primary_location":{"id":"doi:10.1136/bmjopen-2026-125031","doi":"https://doi.org/10.1136/bmjopen-2026-125031","is_oa":true,"landing_page_url":"https://doi.org/10.1136/bmjopen-2026-125031","pdf_url":"https://bmjopen.bmj.com/content/bmjopen/16/10/e125031.full.pdf","source":{"id":"https://openalex.org/S79054089","display_name":"BMJ Open","issn_l":"2044-6055","issn":["2044-6055"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","dongbi-d","doyens","jufo-1","ki-jl-1","medline","norway-1","oarl","poland-100","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310319945","host_organization_name":"BMJ","host_organization_lineage":["https://openalex.org/P4310319945"],"host_organization_lineage_names":["BMJ"],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"BMJ Open","raw_type":"journal-article"},"volume":null,"type":"review","indexed_in":["crossref","doaj","pubmed"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://bmjopen.bmj.com/content/bmjopen/16/10/e125031.full.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5113200242","display_name":"Tran Quang Duc","orcid":"https://orcid.org/0000-0002-7875-1985","observed_orcids":["https://orcid.org/0000-0002-7875-1985"]},"institutions":[{"id":"https://openalex.org/I4387155935","display_name":"HUTECH University","ror":"https://ror.org/05xpj2n48","country_code":"VN","type":"education","lineage":["https://openalex.org/I4387155935"]}],"countries":["VN"],"is_corresponding":false,"raw_author_name":"Tran Quang Duc","raw_affiliation_strings":["HUTECH Institute of Applied Sciences, HUTECH University, Ho Chi Minh City, Vietnam"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"HUTECH Institute of Applied Sciences, HUTECH University, Ho Chi Minh City, Vietnam","institution_ids":["https://openalex.org/I4387155935"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5069936465","display_name":"Khanh Nguyen Di","orcid":"https://orcid.org/0000-0001-7937-8695","observed_orcids":["https://orcid.org/0000-0001-7937-8695"]},"institutions":[{"id":"https://openalex.org/I4405277126","display_name":"Tr\u01b0\u1eddng \u0110\u1ea1i h\u1ecdc C\u00f4ng ngh\u1ec7 \u0110\u1ed3ng Nai","ror":"https://ror.org/01j85cs18","country_code":"VN","type":"education","lineage":["https://openalex.org/I4405277126"]}],"countries":["VN"],"is_corresponding":true,"raw_author_name":"Khanh Nguyen Di","raw_affiliation_strings":["Faculty of Technology, Dong Nai Technology University, Dong Nai, Vietnam","Technology, Medicine and Social Sciences Research Group, Dong Nai Technology University, Dong Nai, Vietnam"],"raw_orcid":"https://orcid.org/0000-0001-7937-8695","affiliations":[{"raw_affiliation_string":"Faculty of Technology, Dong Nai Technology University, Dong Nai, Vietnam","institution_ids":["https://openalex.org/I4405277126"]},{"raw_affiliation_string":"Technology, Medicine and Social Sciences Research Group, Dong Nai Technology University, Dong Nai, Vietnam","institution_ids":["https://openalex.org/I4405277126"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5010453532","display_name":"Dang Dang Khoa","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210134642","display_name":"Lac Hong University","ror":"https://ror.org/03nypmk85","country_code":"VN","type":"education","lineage":["https://openalex.org/I4210134642"]}],"countries":["VN"],"is_corresponding":false,"raw_author_name":"Dang Dang Khoa","raw_affiliation_strings":["Lac Hong University, Dong Nai, Vietnam"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Lac Hong University, Dong Nai, Vietnam","institution_ids":["https://openalex.org/I4210134642"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":3,"corresponding_author_ids":["https://openalex.org/A5069936465"],"corresponding_institution_ids":["https://openalex.org/I4405277126"],"apc_list":{"value":1500,"currency":"GBP","value_usd":1839},"apc_paid":{"value":1500,"currency":"GBP","value_usd":1839},"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.71350838,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"16","issue":"10","first_page":"e125031","last_page":"e125031"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10394","display_name":"Lipoproteins and Cardiovascular Health","score":0.9984999895095825,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10394","display_name":"Lipoproteins and Cardiovascular Health","score":0.9984999895095825,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10027","display_name":"Diabetes, Cardiovascular Risks, and Lipoproteins","score":0.0007999999797903001,"subfield":{"id":"https://openalex.org/subfields/2712","display_name":"Endocrinology, Diabetes and Metabolism"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11618","display_name":"Cholesterol and Lipid Metabolism","score":9.999999747378752e-05,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/cardiovascular-events","display_name":"cardiovascular events","score":0.9160000085830688},{"id":"https://openalex.org/keywords/atherogenic-lipids","display_name":"atherogenic lipids","score":0.7519999742507935},{"id":"https://openalex.org/keywords/cardiovascular-risk","display_name":"cardiovascular risk","score":0.8069999814033508},{"id":"https://openalex.org/keywords/prospective-cohort-study","display_name":"prospective cohort","score":0.4519999921321869},{"id":"https://openalex.org/keywords/risk-of-bias","display_name":"risk of bias","score":0.44999998807907104}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.9294000267982483},{"id":"https://openalex.org/C188816634","wikidata":"https://www.wikidata.org/wiki/Q2113324","display_name":"Prospective cohort study","level":2,"score":0.7634000182151794},{"id":"https://openalex.org/C68443243","wikidata":"https://www.wikidata.org/wiki/Q2786686","display_name":"Quartile","level":3,"score":0.6043999791145325},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.5346999764442444},{"id":"https://openalex.org/C95190672","wikidata":"https://www.wikidata.org/wiki/Q815382","display_name":"Meta-analysis","level":2,"score":0.4684999883174896},{"id":"https://openalex.org/C201903717","wikidata":"https://www.wikidata.org/wiki/Q1778788","display_name":"Cohort study","level":2,"score":0.45329999923706055},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.4307999908924103},{"id":"https://openalex.org/C72563966","wikidata":"https://www.wikidata.org/wiki/Q1303415","display_name":"Cohort","level":2,"score":0.38449999690055847},{"id":"https://openalex.org/C12174686","wikidata":"https://www.wikidata.org/wiki/Q1058438","display_name":"Risk assessment","level":2,"score":0.38269999623298645},{"id":"https://openalex.org/C77350462","wikidata":"https://www.wikidata.org/wiki/Q1125472","display_name":"Confounding","level":2,"score":0.3580000102519989},{"id":"https://openalex.org/C107130276","wikidata":"https://www.wikidata.org/wiki/Q133805","display_name":"Epidemiology","level":2,"score":0.3264000117778778},{"id":"https://openalex.org/C189708586","wikidata":"https://www.wikidata.org/wiki/Q1504425","display_name":"Systematic review","level":3,"score":0.31700000166893005},{"id":"https://openalex.org/C207103383","wikidata":"https://www.wikidata.org/wiki/Q3930246","display_name":"Hazard ratio","level":3,"score":0.30720001459121704},{"id":"https://openalex.org/C2778163477","wikidata":"https://www.wikidata.org/wiki/Q43656","display_name":"Cholesterol","level":2,"score":0.30230000615119934},{"id":"https://openalex.org/C50382708","wikidata":"https://www.wikidata.org/wiki/Q223218","display_name":"Proportional hazards model","level":2,"score":0.29989999532699585},{"id":"https://openalex.org/C140556311","wikidata":"https://www.wikidata.org/wiki/Q214746","display_name":"Biostatistics","level":3,"score":0.2973000109195709},{"id":"https://openalex.org/C116567970","wikidata":"https://www.wikidata.org/wiki/Q864217","display_name":"Biobank","level":2,"score":0.29100000858306885},{"id":"https://openalex.org/C2777466982","wikidata":"https://www.wikidata.org/wiki/Q5227287","display_name":"Data extraction","level":3,"score":0.2883000075817108},{"id":"https://openalex.org/C107673813","wikidata":"https://www.wikidata.org/wiki/Q812534","display_name":"Bayesian probability","level":2,"score":0.26930001378059387},{"id":"https://openalex.org/C50440223","wikidata":"https://www.wikidata.org/wiki/Q1475848","display_name":"Risk factor","level":2,"score":0.25589999556541443},{"id":"https://openalex.org/C23131810","wikidata":"https://www.wikidata.org/wiki/Q818574","display_name":"Observational study","level":2,"score":0.2551000118255615},{"id":"https://openalex.org/C2776104379","wikidata":"https://www.wikidata.org/wiki/Q21112670","display_name":"Lipoprotein(a)","level":4,"score":0.2508000135421753}],"mesh":[],"locations_count":4,"locations":[{"id":"doi:10.1136/bmjopen-2026-125031","doi":"https://doi.org/10.1136/bmjopen-2026-125031","is_oa":true,"landing_page_url":"https://doi.org/10.1136/bmjopen-2026-125031","pdf_url":"https://bmjopen.bmj.com/content/bmjopen/16/10/e125031.full.pdf","source":{"id":"https://openalex.org/S79054089","display_name":"BMJ Open","issn_l":"2044-6055","issn":["2044-6055"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","dongbi-d","doyens","jufo-1","ki-jl-1","medline","norway-1","oarl","poland-100","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310319945","host_organization_name":"BMJ","host_organization_lineage":["https://openalex.org/P4310319945"],"host_organization_lineage_names":["BMJ"],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"BMJ Open","raw_type":"journal-article"},{"id":"pmh:oai:pubmedcentral.nih.gov:13684149","doi":null,"is_oa":true,"landing_page_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13684149/","pdf_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13684149/pdf/bmjopen-16-10.pdf","source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"BMJ Open","raw_type":"Text"},{"id":"pmid:42901588","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42901588","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"BMJ open","raw_type":"Journal Article"},{"id":"pmh:oai:doaj.org/article:2687248503264dcf82bb85a2a15798f5","doi":null,"is_oa":false,"landing_page_url":"https://doaj.org/article/2687248503264dcf82bb85a2a15798f5","pdf_url":null,"source":{"id":"https://openalex.org/S4306401280","display_name":"DOAJ (DOAJ: Directory of Open Access Journals)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"BMJ Open, Vol 16, Iss 10 (2026)","raw_type":"article"}],"best_oa_location":{"id":"doi:10.1136/bmjopen-2026-125031","doi":"https://doi.org/10.1136/bmjopen-2026-125031","is_oa":true,"landing_page_url":"https://doi.org/10.1136/bmjopen-2026-125031","pdf_url":"https://bmjopen.bmj.com/content/bmjopen/16/10/e125031.full.pdf","source":{"id":"https://openalex.org/S79054089","display_name":"BMJ Open","issn_l":"2044-6055","issn":["2044-6055"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","dongbi-d","doyens","jufo-1","ki-jl-1","medline","norway-1","oarl","poland-100","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310319945","host_organization_name":"BMJ","host_organization_lineage":["https://openalex.org/P4310319945"],"host_organization_lineage_names":["BMJ"],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"BMJ Open","raw_type":"journal-article"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","score":1.0,"display_name":"Good health and well-being"}],"study_designs":[{"id":"https://openalex.org/study-designs/systematic-review","display_name":"Systematic Review"},{"id":"https://openalex.org/study-designs/meta-analysis","display_name":"Meta-Analysis"}],"awards":[],"funders":[],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7223051670.pdf","grobid_xml":"https://content.openalex.org/works/W7223051670.grobid-xml"},"referenced_works_count":34,"referenced_works":["https://openalex.org/W1520609538","https://openalex.org/W2016364578","https://openalex.org/W2043265520","https://openalex.org/W2057623254","https://openalex.org/W2066719367","https://openalex.org/W2151823126","https://openalex.org/W2530844910","https://openalex.org/W2558385865","https://openalex.org/W2596179513","https://openalex.org/W2801713528","https://openalex.org/W2899997727","https://openalex.org/W2919780704","https://openalex.org/W2982773910","https://openalex.org/W3012187678","https://openalex.org/W3092606086","https://openalex.org/W3092750952","https://openalex.org/W3125724272","https://openalex.org/W3131922517","https://openalex.org/W3153225771","https://openalex.org/W3176105395","https://openalex.org/W3217328985","https://openalex.org/W4220676154","https://openalex.org/W4230914943","https://openalex.org/W4304480447","https://openalex.org/W4311457512","https://openalex.org/W4313575777","https://openalex.org/W4318919281","https://openalex.org/W4376603866","https://openalex.org/W4386262246","https://openalex.org/W4413115711","https://openalex.org/W4414487033","https://openalex.org/W4415149571","https://openalex.org/W7139119803","https://openalex.org/W7140132174"],"related_works":["https://openalex.org/W2057623254","https://openalex.org/W4415149571","https://openalex.org/W3102495059","https://openalex.org/W4391614370","https://openalex.org/W7213240022","https://openalex.org/W4400959553","https://openalex.org/W115061695","https://openalex.org/W2091219877","https://openalex.org/W4214944567","https://openalex.org/W3156789823"],"abstract_inverted_index":{"Objectives":[0],"Small":[1],"dense":[2],"low-density":[3],"lipoprotein":[4],"cholesterol":[5],"(sdLDL-C)":[6],"is":[7,278],"considered":[8],"one":[9],"of":[10,38,51,69,85,153,252,297],"the":[11,121,179,182,242,268],"most":[12],"atherogenic":[13,298],"lipid":[14],"fractions,":[15],"but":[16],"its":[17],"association":[18,193],"with":[19,280],"cardiovascular":[20,94,176,283,299],"events":[21,95],"and":[22,36,49,67,104,127,132,151,157,172,226,244,265,270,290],"whether":[23],"this":[24,44],"differs":[25],"by":[26,110,138],"assessment":[27,140,160],"method":[28],"remain":[29],"uncertain.":[30],"We":[31],"conducted":[32],"a":[33,231],"systematic":[34],"review":[35,48],"meta-analysis":[37,50],"prospective":[39,52],"cohort":[40,83],"studies":[41,84,165],"to":[42,77,190,207,215,256],"quantify":[43],"association.":[45],"Design":[46],"Systematic":[47],"cohorts;":[53],"PROSPERO":[54],"registered":[55],"(CRD420261411427).":[56],"Data":[57,102,106],"sources":[58],"PubMed,":[59],"ProQuest":[60],"Health":[61],"&":[62],"Medical":[63],"Collection,":[64],"MEDLINE":[65],"(Ovid)":[66],"Web":[68],"Science":[70],"Core":[71],"Collection":[72],"were":[73,100,107,161,166],"searched":[74],"from":[75],"inception":[76],"June":[78],"2026.":[79],"Eligibility":[80],"criteria":[81],"Prospective":[82],"community-based":[86],"or":[87],"population-based":[88],"adults":[89],"reporting":[90],"HRs":[91,119],"for":[92,120,128,196,262,267],"incident":[93,175,282],"across":[96],"baseline":[97,276],"sdLDL-C":[98,125,139,201,264,277],"categories":[99,126],"eligible.":[101],"extraction":[103],"synthesis":[105],"extracted":[108],"independently":[109],"two":[111],"reviewers.":[112],"Random-effects":[113],"restricted":[114],"maximum":[115],"likelihood":[116],"models":[117],"pooled":[118,183],"highest":[122],"versus":[123,134],"lowest":[124],"quartile":[129],"(Q)2,":[130],"Q3":[131],"Q4":[133],"Q1":[135],"comparisons,":[136],"stratified":[137],"method.":[141],"Sensitivity":[142],"analyses,":[143],"risk-of-bias":[144],"assessment,":[145],"Bayesian":[146,227],"hierarchical":[147],"relative-to-an-identified-distribution":[148],"(RIDIT)-based":[149],"modelling":[150],"Grading":[152],"Recommendations,":[154],"Assessment,":[155],"Development":[156],"Evaluations":[158],"(GRADE)":[159],"performed.":[162],"Results":[163],"Fourteen":[164],"included,":[167],"comprising":[168],"738":[169],"114":[170],"participants":[171],"77":[173],"839":[174],"events.":[177],"In":[178],"highest-versus-lowest":[180],"comparison,":[181],"HR":[184,210],"was":[185,194,219,254,260],"1.47":[186],"(95%":[187],"CI":[188,205,213],"1.32":[189],"1.63).":[191],"The":[192],"stronger":[195],"directly":[197,271],"measured":[198,272],"than":[199],"calculated":[200,263],"(HR":[202],"1.64,":[203],"95%":[204,212],"1.38":[206],"1.94":[208],"vs":[209],"1.37,":[211],"1.21":[214],"1.54).":[216],"Between-study":[217],"heterogeneity":[218],"substantial":[220],"in":[221,286],"several":[222],"analyses.":[223,273],"Pairwise":[224],"quantile":[225],"RIDIT-based":[228],"analyses":[229,237],"supported":[230],"graded":[232],"positive":[233],"exposure\u2013risk":[234],"pattern.":[235],"Leave-one-out":[236],"did":[238],"not":[239],"materially":[240],"change":[241],"estimates,":[243],"Egger\u2019s":[245],"tests":[246],"showed":[247],"no":[248],"small-study":[249],"effects.":[250],"Risk":[251],"bias":[253],"low":[255,266],"moderate.":[257],"GRADE":[258],"certainty":[259],"moderate":[261],"overall":[269],"Conclusion":[274],"Higher":[275],"associated":[279],"increased":[281],"event":[284],"risk":[285],"general":[287],"adult":[288],"populations":[289],"may":[291],"serve":[292],"as":[293],"an":[294],"accessible":[295],"marker":[296],"risk.":[300]},"counts_by_year":[],"updated_date":"2026-10-29T09:56:32.521200","created_date":"2026-10-21T00:00:00"}