The De Ritis Ratio as a Surrogate Marker for NMR-Derived Atherogenic Lipoprotein Subfractions: A Large-Scale Analysis

10th International Conferences on Science and Technology (ICONST), Budapest, Macaristan, 1 - 03 Temmuz 2026, ss.13, (Özet Bildiri)

Abstract: This study investigated the relationship between the De Ritis ratio (AST/ALT) and comprehensive lipid

profiles, specifically Nuclear Magnetic Resonance (NMR)-derived low-density lipoprotein (LDL) subfractions, to

evaluate its potential as a prognostic factor for cardiovascular risk in a large-scale cohort. A cross-sectional study was

conducted involving 27,172 individuals aged 18 to 90 years. Serum AST and ALT levels were quantified alongside

detailed lipoprotein profiling, which included the measurement of six LDL subfractions (LDL-1 to LDL-6) using IVDr

NMR spectroscopy. Data were statistically evaluated utilizing Kruskal-Wallis tests, Spearman’s rank correlation analysis,

and standardized binary logistic regression to assess associations and metabolic risk predictors. The analysis revealed that

a low De Ritis ratio (<1.0) was strongly associated with an atherogenic lipid phenotype. Specifically, as the AST/ALT

ratio decreased, there were significant elevations in triglycerides and small dense LDL (sdLDL) particles, namely the

highly atherogenic LDL-4, LDL-5, and LDL-6 subfractions, while high-density lipoprotein (HDL) cholesterol levels

declined. Logistic regression identified male gender, elevated triglycerides, and specific sdLDL subfractions (LDL-5 and

LDL-6) as significant independent predictors of a low De Ritis ratio. Notably, total LDL-cholesterol was not found to be

a strong determinant of this atherogenic phenotype. A low De Ritis ratio functions as a robust surrogate biomarker for

atherogenic dyslipidemia characterized by elevated sdLDL particles, which are frequently overlooked by standard lipid

panels. This ratio provides enhanced granularity for cardiovascular risk stratification, reflecting a high-risk metabolic

profile independent of conventional total LDL cholesterol levels.