Desialylated low-density lipoprotein: A stronger predictor of coronary atherosclerosis burden than low-density lipoprotein cholesterol.

Introduction: This study aimed to investigate the relationship between plasma desialylated low-density lipoprotein (desLDL) levels and the severity of coronary artery disease (CAD), and to evaluate the potential value of desLDL as a biomarker for disease stratification and risk prediction. Methods: This study was conducted at Affiliated Nanhua Hospital, University of South China between December 2024 and June 2025. A total of 162 patients undergoing coronary angiography were enrolled and categorised into a CAD group (n=78) and a non-CAD group (n=84) based on the presence of ≥50% coronary stenosis. Plasma desLDL levels were quantified by liquid chromatography-mass spectrometry (LC-MS). Receiver operating characteristic (ROC) analysis compared the diagnostic performance of desLDL with conventional lipid parameters, and multivariable logistic regression was applied to assess the independent predictive value of desLDL. Results: Plasma desLDL levels were significantly higher in the CAD group than in controls. Among CAD patients, those with >2 diseased vessels had higher desLDL levels than those with ≤2 vessels, and both exceeded control values (P <0.001). The ROC area under the curve was 0.836 (95% confidence interval [CI] 0.779–0.893); a threshold of 2.25 mmol/L provided 75.6% sensitivity and 84.2% specificity, outperforming LDL cholesterol and total cholesterol. Multivariable analysis identified desLDL as the strongest independent predictor of CAD (adjusted odds ratio 5.85, 95% CI 2.69–12.69). DesLDL elevations were similar in acute myocardial infarction and stable CAD presentations, while both remained significantly higher than controls. Conclusion: Elevated plasma desLDL levels were significantly associated with the presence of CAD and reflected anatomical disease burden, demonstrating superior predictive performance compared with conventional lipid markers.