Evidence map›Paper›PMID 42291078›Full record

ArticleAmerican journal of preventive cardiology2026

Small, dense LDL-C as a predictor of cardiovascular risk and benefit of alirocumab in patients with recent acute coronary syndrome receiving optimized statin treatment.

Gregory G Schwartz, Michael Szarek, Christa M Cobbaert, L Renee Ruhaak, Markus Schwertfeger, Deepak L Bhatt, Vera A Bittner, Shaun G Goodman, Robert A Harrington, Irena Stevanovic and 7 more

Abstract read
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In one paragraph

Article in American journal of preventive cardiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors.

Gregory G SchwartzDivision of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA.
Michael SzarekDivision of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA.
Christa M CobbaertDepartment of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, The Netherlands.
L Renee RuhaakDepartment of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, The Netherlands.
Markus SchwertfegerRoche Diagnostics, Zug, Switzerland.
Deepak L BhattMount Sinai Fuster Heart Hospital, Icahn School of Medicine, New York, NY, USA.
Vera A BittnerDivision of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA.
Shaun G GoodmanCanadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
Robert A HarringtonWeill Cornell Medicine, New York, NY.
Irena StevanovicSanofi, Paris, France.
Hagai TavoriYakum, Israel.
Esther ReijndersDepartment of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, The Netherlands.
Fred RomijnDepartment of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, The Netherlands.
Nicolaas J M van NeerDepartment of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, The Netherlands.
Harvey D WhiteGreen Lane Cardiovascular Research Unit, Te Whatu Ora-Health New Zealand, Te Toka Tumai, and University of Auckland, New Zealand.
J W JukemaDepartment of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
P Gabriel StegUniversité Paris-Cité, INSERM-UMR1148, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, French Alliance for Cardiovascular Trials, and Institut Universitaire de France, Paris, France.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Introduction: Small, dense low-density lipoprotein (sdLDL) particles are considered a highly atherogenic subfraction of LDL. Automated biochemical measurement of sdLDL cholesterol (sdLDL-C) has good fidelity to gold-standard measurements. We evaluated relationships of sdLDL-C and LDL-C to risk of major adverse cardiovascular events (MACE) and treatment benefit of the PCSK9-directed monoclonal antibody alirocumab in patients with recent acute coronary syndrome (ACS) and elevated atherogenic lipoproteins despite optimized statin treatment. Methods: Analyses comprised 11,837 participants in the ODYSSEY OUTCOMES trial randomized to receive alirocumab or placebo. sdLDL-C was measured using the Denka method; baseline LDL-C was calculated with the Friedewald formula. In the placebo group ( Results: Over 2.8 years median follow-up, risk of MACE in the placebo group increased with higher baseline sdLDL-C or LDL-C with nearly superimposable splines and without variation according to sdLDL-C/LDL-C. Findings were similar in patients with greater or lesser degrees of insulin resistance. Alirocumab reduced risk of MACE (HR 0.87, 95% CI 0.79, 0.95). Treatment HR did not vary significantly across the range of LDL-C or sdLDL-C. Conclusion: In patients with recent ACS on optimized statin treatment, sdLDL-C and LDL-C similarly predict risk of MACE and benefit of alirocumab treatment. Measurement of sdLDL-C does not appear to provide additional prognostic or predictive information in this population.

Indexed as

Acute coronary syndromeAlirocumabSmall, dense LDL

Identifiers

PMID42291078
PMCPMC13261218

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.