The Importance of Maintaining Regular Dietary Patterns to reduce CVD risk

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The Importance of Maintaining Regular Dietary Patterns to reduce CVD risk

Cardiovascular disease (CVD) is the leading cause of mortality worldwide. An estimated 17.9 million people died from some form of CVD in 2019, accounting for 32% of all-cause mortality that year1. Associations between diet and risk of cardiovascular complications have long been established, largely relating to alterations in lipid profiles.

For as long as anyone can remember, breakfast has been considered the most important meal of the day. Previous studies2 have shown an association between skipping breakfast and increased CVD risk prompting recommendations that up to 30% of one’s daily energy intake should be consumed during the first meal of the day. It has been reported that over 25% of adults skip breakfast. These individuals are often socioeconomically disadvantaged, shift workers, individuals who work particularly long hours, those who suffer from depression or those with poor health literacy2. Another study3 showed that skipping breakfast, when compared with consuming a high-energy breakfast, was associated with a 1.6x and 2.6x higher probability of non-coronary and general atherosclerosis respectively, when all other CVD risk factor had been controlled. This suggests a close relationship between eating breakfast and reducing CVD risk, however, the mechanisms and magnitude of this relationship are poorly understood.

Small, dense low-density lipoprotein cholesterol (sdLDL-C) is a smaller form of LDL-C which boasts greater propensity for uptake by arterial tissue, increased proteoglycan binding, and increased susceptibility for oxidation4. sdLDL-C concentration is strongly associated with CVD risk, yet once again, the mechanisms of this association remain enigmatic. It is thought that all of the metabolic changes associated with alterations in sdLDL-C concentration collectively contribute to the increased risk of CVD, with the main drivers being its propensity for uptake by arterial tissues and its long circulatory stability4

Skipping breakfast and sdLDL-C

A recent study investigated the relationship between skipping breakfast and the effects on lipid parameters5. In a cohort of around 28’000 people from the Japanese population, this study looked at the several markers, including sdLDL-C, to develop an understanding of the importance of regular dietary patterns for reducing the risk of CVD.

The study participants were divided into two main categories: breakfast eaters and breakfast skippers. These categories were further subdivided to differentiate men and women, over and under 55 years old, and those who eat staple products (rice, pasta, bread, etc.) and those who did not. The participants contributed blood samples which were tested for several cardiovascular biomarkers: Creatinine, Liver ALT, Total Cholesterol, Triglycerides, direct LDL-C, HDL-C and sdLDL-C.

They found that around 26% of men and 16.9% of women skipped breakfast regularly. Of these, most were considered young and had significant increases in concentration of triglycerides, LDL-C and sdLDL-C compared with those who ate breakfast almost every day.

Table 1. Median concentration of triglycerides, LDL-C, and sdLDL-C for breakfast skippers and eaters5

Analyte Breakfast Skippers (mg/dL) Breakfast Eaters (mg/dL)
Triglycerides 103 93
LDL-C 124 122
sdLDL-C 34.7 32

This investigation also revealed that in this cohort, 20% of men and 27.3% of women did not regularly consume staple foods as part of their diet and had higher median sdLDL-C concentration.

Table 2. Median concentration of sdLDL-C in men and women who eat or skip staple food products in their diet5

Gender Staple Skippers (mg/dL) Staple Eaters (mg/dL)
Men 34.1 31.6
Women 25.8 24.7

The data from this study supports the finding that individuals who skipped breakfast had higher sdLDL-C concentrations than those who ate breakfast consistently. Skipping breakfast can therefore be associated with troublesome lipid parameters in both genders and all age groups in the Japanese population. This study suggests that eating breakfast every day is crucial to maintain beneficial lipid parameters and reduce the risk of developing CVD.

The data also show that individuals who skipped staple foods in their meals presented with higher concentrations of sdLDL-C and a higher sdLDL-C/LDL-C ratio, in men and postmenopausal women, when compared with those who included staple foods in their meals. It is becoming increasingly common to remove staple foods from one’s diet due to their high carbohydrate content and the prevalence of low-carbohydrate diets. This data exhibits the importance of maintaining a nutritionally balanced diet to help reduce the risk of developing CVD.

As the first large scale study of its kind, this analysis provides clear insight into the increased risk of CVD associated with not only skipping breakfast, but failing to maintain a nutritionally balanced diet. The major limitation of this analysis is that it only includes individuals from the Japanese population and the same affects may not be seen in populations from other ethnicities. Therefore, further in-depth analysis is required to confirm these findings in other ethnicities


Randox sdLDL-C Assay

The Randox sdLDL-C assay employs the clearance method which displays good correlation with the gold standard in sdLDL-C quantification, giving laboratories increased confidence in their results first time, every time. Supplied as liquid ready-to-use reagents, this this test can be applied to a wide range of clinical chemistry analysers, producing results in as little as 10 minutes. Relevant controls and calibrators are also available from Randox as part of the Acusera range.

Randox sdLDL-C Assay Key Features

  • Direct, automated test for convenience and efficiency.
  • Rapid analysis results can be produced in as little as ten minutes, facilitating faster patient diagnosis and treatment plan implementation.
  • Liquid ready-to-use reagents for convenience and ease of use.
  • Applications available detailing instrument specific settings for a wide range of clinical chemistry analysers.
  • sdLDL-C controls and calibrator available.


  1. World Health Organization. Cardiovascular Diseases. World Health Organization. Published June 11, 2021.
  2. Ofori-Asenso R, Owen AJ, Liew D. Skipping Breakfast and the Risk of Cardiovascular Disease and Death: A Systematic Review of Prospective Cohort Studies in Primary Prevention Settings. Journal of Cardiovascular Development and Disease. 2019;6(3):30. doi:
  3. Uzhova I, Fuster V, Fernández-Ortiz A, et al. The Importance of Breakfast in Atherosclerosis Disease. Journal of the American College of Cardiology. 2017;70(15):1833-1842. doi:
  4. Rizvi AA, Stoian AP, Janez A, Rizzo M. Lipoproteins and cardiovascular disease: An update on the clinical significance of atherogenic small, dense LDL and new therapeutical options. Biomedicines. 2021;9:1579. doi:
  5. Arimoto M, Yamamoto Y, Imaoka W, et al. Small dense low-density lipoprotein cholesterol levels in breakfast skippers and staple food skippers. Journal of Atherosclerosis and Thrombosis. 2023;30. doi:

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Randox Reagents H-FABP & AKI

sdLDL Cholesterol Assay

Reagent | Small Dense LDL Cholesterol (sdLDL-C)

Size Matters: The True Weight of Risk in Lipid Profiling

Benefits of the Randox sdLDL-C Assay

Superior Performance

Superior method

The clearance method produces results in as little as ten minutes, facilitating faster patient diagnosis and treatment plan implementation. The previous methods, ultracentrifugation and electrophoresis, were laborious and time consuming.

Exceptional correlation

correlation coefficient of r=0.91 was displayed when the Randox methodology was compared against the gold standard method, ultracentrifugation.

Liquid ready-to-use assay

The Randox sdLDL-C assay is available in a liquid ready-to-use format for convenience and ease-of-use.

Calibrator & Controls

Dedicated calibrator and control available

Dedicated sdLDL-C calibrator and control available offering a complete testing package.

Applications available

Applications are available detailing instrument-specific settings for the convenient use of the Randox sdLDL-C assay on a wide range of clinical chemistry analysers.

  • Ordering Information
  • Physiological Significance
  • Risk Assessment
  • Management
  • Methods of Detection
Cat NoSize
562616R1 1 x 19.8ml (L)
R2 1 x 8.6ml
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CH8153R1 1 x 16.2ml (L)
R2 1 x 8.2ml
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562760 (U)R1 1 x 18ml
R2 1 x 7ml
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562791 *(U)R1 5 x 200ml EnquireKit Insert RequestMSDSBuy Online
562807 *(U)R2 2 x 200mlEnquireKit Insert RequestMSDSBuy Online
(L) Indicates a liquid reagent
(U) Indicates for use in the USA only
(*) Indicates that boths kits must be purchased together

Instrument Specific Applications (ISA’s) are available for a wide range of biochemistry analysers.  Contact us to enquire about your specific analyser.

When measuring LDL cholesterol (LDL-C), it is the cholesterol mass within the LDL particles that is being measured. The LDL particle population within LDL is heterogeneous – meaning that the size, density & composition of each particle will be different. sdLDL-C is a subfraction of low density lipoprotein (LDL) with smaller particle size and higher density than larger more buoyant LDL. They all transport triglycerides and cholesterol to the tissues, but their atherogenesis varies according to their size. sdLDL-C will more readily permeate the inner arterial wall. sdLDL-C is more susceptible to oxidation and has a lower affinity to the hepatic LDL receptor, and as such circulates in the blood longer1.

As sdLDL-C is particularly atherogenic, a person with elevated sdLDL-C levels has a 3-fold increased risk of myocardial infarction (MI)2.
sdLDL-C measurement therefore provides a more comprehensive understanding of cardiovascular disease (CVD) risk compared to traditional LDL-C tests.

sdLDL-C Scale

Reducing sdLDL-C levels will aid in reducing the risk of CVD and MI. High dose statin therapy has been proven to aid in reducing the levels of sdLDL-C as a risk factor for cardiovascular events and high risk patients. Elevated levels of sdLDL-C arise from multiple sources. A major factor is a sedentary lifestyle with a diet high in saturated fat. Insulin resistance and pre-diabetes have also been implicated, in addition to genetic predisposition3.

The measurement of LDL-C or the review of levels within arteriosclerotic coronary heart disease (ASCHD) treatment are known within different guidelines (including ATP III, AHA/ ACC, ESC/ EAS and NICE). However doubt remains on the impact of targeting LDL-C only. The inclusion of sdLDL-C within the clinical testing panel will assist in removing this doubt.

The Randox sdLDL-C test is a direct method for the quantitative determination of sdLDL-C using a range of chemistry analysers capable of accommodating two-reagent assays. The assay consists of two steps and is based on the use of well-characterised surfactants and enzymes that selectively react with certain groups of lipoproteins.

sdLDL-C Calibrator

sdLDL-C Control

Lipid EQA Scheme

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