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Small dense low-density lipoprotein in primary biliary cholangitis: Independent association with metabolic syndrome
Tomas Koky, Sylvia Drazilova, Martin Janicko, Martin Harhovsky, Peter Jarcuska, 2nd Department of Internal Medicine, PJ Safarik University, Faculty of Medicine and L Pasteur University Hospital, Kosice 04011, Slovakia
Beata Hubkova, Ivana Tothova, Miroslava Rabajdova, Maria Marekova, Department of Medical and Clinical Biochemistry, PJ Safarik University, Faculty of Medicine, Kosice 04011, Slovakia
Author contributions: Koky T wrote the paper and contributed to the analysis; Drazilova S designed, conducted and supervised the study; Harhovsky M, Janicko M and Hubkova B and Tothova I contributed to the analysis; Rabajdova M and Marekova M provided clinical advice; Jarcuska P supervised the study.
AI contribution statement: Portions of this manuscript were edited using AI tools for language refinement. The authors were responsible and agree to accountability for all scientific content.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Faculty of Medicine of Pavol Jozef Šafárik University, Košice.
Informed consent statement: Each patient provided written informed consent for the examinations and inclusion in the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Technical appendix, statistical code, and dataset are available from the corresponding author at sylvia.drazilova@upjs.sk.
Corresponding author: Sylvia Drazilova, MD, PhD, Associate Professor, 2nd Department of Internal Medicine, PJ Safarik University, Faculty of Medicine and L Pasteur University Hospital, Trieda SNP 1, Kosice 04011, Slovakia. sylvia.drazilova@upjs.sk
Received: June 15, 2026
Revised: July 13, 2026
Accepted: July 27, 2026
Published online: August 27, 2026
Processing time: 64 Days and 13.2 Hours
Revised: July 13, 2026
Accepted: July 27, 2026
Published online: August 27, 2026
Processing time: 64 Days and 13.2 Hours
Core Tip
Core Tip: Hypercholesterolemia in primary biliary cholangitis (PBC) is largely driven by cholestasis and lipoprotein X, making conventional lipid parameters difficult to interpret. In this study, small dense low-density lipoprotein (LDL) was independently associated with metabolic syndrome but not with liver fibrosis, cholestatic activity, metabolic dysfunction-associated steatotic liver disease, or biochemical response. These findings suggest that small dense LDL reflects supe