Background: We aimed to assess the association of small dense low-density lipoprotein (sdLDL) – a novel lipid marker for cardiovascular disease (CVD) risk estimation in Indians with the meta-analysis approach. Methods: Various databases, namely PubMed, MEDLINE, and EMBASE, were used to identify the prospective studies showing an association between CVD risk and lipid profile in the Indian population. Heterogeneity was assessed using Q and I 2 statistics, and data were expressed using the standardized mean difference (SMD) with 95% confidence interval (CI). Results: After database search, six eligible studies assessing levels of sdLDL and LDL in Indian patients with premature CVD were identified. Level of sdLDL was found to have positive relation with CVD risk in Indians (SMD = 1.352, 95% CI: 0.744–1.96 mg/dL, I 2 94.04%, P < 0.001) along with LDL (SMD = 0.680, 95% CI: 0.180–1.180 mg/dL) levels. However, the degree of association was greater with sdLDL. Conclusions: The current meta-analysis clearly identifies sdLDL as the better marker of premature CVD in Indians, especially in case of normal values of classical markers such as LDL.