ASSOCIATION BETWEEN DYSLIPIDEMIA PATTERNS AND CARDIOVASCULAR MORTALITY IN HIGH-RISK INDIVIDUALS

Abstract

Dyslipidemia is a major modifiable risk factor for atherosclerotic cardiovascular disease; however, substantial residual cardiovascular risk persists despite optimal low-density lipoprotein cholesterol (LDL-C) lowering.This study aimed to experimentally evaluate the contribution of complex dyslipidemia patterns, including triglyceride-rich lipoproteins and remnant cholesterol, to cardiovascular mortality in high-risk populations.A mixed-methods experimental design integrating quantitative longitudinal lipid analysis with qualitative clinical interpretation was employed. Comprehensive lipid profiling, derived atherogenic indices, and multivariate survival modeling were used to assess associations with cardiovascular outcomes. Composite lipid models incorporating triglycerides, non–high-density lipoprotein cholesterol, and remnant cholesterol demonstrated significantly superior predictive performance compared with LDL-C–only frameworks. Nonlinear interactions among triglycerides, HDL-C, and small dense LDL surrogates revealed amplified residual cardiovascular risk independent of LDL-C levels. Multivariate hazard modeling confirmed that cholesterol-rich remnant particles and triglyceride-rich lipoproteins were dominant predictors of cardiovascular mortality, exhibiting greater stability and robustness across sensitivity analyses. Visual and quantitative analyses consistently showed persistent risk despite achievement of LDL-C targets.The findings indicate that residual cardiovascular risk is predominantly driven by non-LDL atherogenic lipoproteins, underscoring the inadequacy of LDL-C–centric risk assessment and treatment strategies. Broader lipid profiling and targeted therapeutic approaches addressing triglyceride-rich and remnant lipoproteins are essential to reduce cardiovascular mortality in high-risk populations