Measured Versus Calculated Small Dense LDL-Cholesterol and Cardiometabolic Traits in a South African Population

  • M. Masoud
  • A. P. Kengne
  • R. T. Erasmus
  • G. M. Hon
  • M. Macharia
  • T. E. Matsha
Original Research Article


Small-dense low density lipoprotein (sdLDL) is increasingly viewed as a marker for evaluating atherogenic risk, however its clinical uptake is hampered by the cumbersomeness of available methods. Consequently, a number of alternative methods for the estimation of sdLDL have been developed and none have been tested in a population from Africa. We evaluated an equation to estimate sdLDL-C from classic lipid parameters in South Africans. This is a cross-sectional study involving 1550 participants in which direct measurement of sdLDL in 237 participants was performed using a homogeneous enzymatic assay. Their mean age (standard deviation, SD) was 54.2 (14.7) years. 156 (65.8%) were normotolerant, 29 (12.2%) prediabetes, 17 (7.2%) screen detected diabetes and 35 (14.8%) known diabetes. Measured sdLDL values ranged from 0.17 to 3.39 versus—1.85 to 2.52 mmol/L calculated sdLDL. There was a significant positive correlation between the two measurements with a Pearson correlation coefficient of 0.659 (95%CI: 0.581–0.726). In a regression model, the adjusted R2 was 0.440 after adding age, 0.441 after further adding gender, then 0.443 with dysglycemia and lastly 0.447 upon adding body mass index. With the exception of HDL-cholesterol levels that decreased across increasing quintiles of calculated sdLDL, our data showed significant correlations between sdLDL and cardiometabolic risk factors, all p values < 0.0001. In conclusion, this study has shown that calculated sdLDL can be efficiently used to approximate population levels of sdLDL; however the modest correlation indicate that at the individual level, it will poorly approximate true sdLDL levels, with possible implications for risk stratification.


Africa Diabetes Metabolic syndrome Lipids Small-dense low density lipoprotein 



We thank the Bellville South (Ward 009) community for participating in the study. We are also grateful to the Bellville South community Health Forum for supporting the engagement with the Bellville South community. This research project was funded by the South African Medical Research Council (SAMRC) with funds from National Treasury under its Economic Competitiveness and Support Package (MRC-RFA-UFSP-01-2013/VMH Study) and strategic funds from the SAMRC received from the South African National Department of Health. Any opinion, finding and conclusion or recommendation expressed in this material is that of the author(s) and the MRC does not accept any liability in this regard.


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Copyright information

© Association of Clinical Biochemists of India 2018

Authors and Affiliations

  • M. Masoud
    • 1
  • A. P. Kengne
    • 3
    • 4
  • R. T. Erasmus
    • 2
  • G. M. Hon
    • 1
  • M. Macharia
    • 2
  • T. E. Matsha
    • 1
  1. 1.Department of Biomedical Sciences, Faculty of Health and Wellness ScienceCape Peninsula University of TechnologyBellville, Cape TownSouth Africa
  2. 2.Division of Chemical Pathology, Faculty of Health Sciences, National Health Laboratory Service (NHLS)University of StellenboschCape TownSouth Africa
  3. 3.Non-Communicable Diseases Research UnitSouth African Medical Research CouncilCape TownSouth Africa
  4. 4.Department of MedicineUniversity of Cape TownCape TownSouth Africa

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