LDL Cholesterol, Particle Number and Particle Size Made Easy

Measurements of lipids levels in blood are frequently used to assess the risk of future heart disease. The most commonly used measurements are total cholesterol, triglycerides and high density lipoprotein cholesterol (HDL-C). These numbers are then used to calculate low density lipoprotein cholesterol (LDL-C), which has been found to be strongly correlated with the risk of heart disease.

Recently measurements of atherogenic lipoprotein particles, such as LDL-P (LDL particle number), apolipoprotein B (apoB) and lipoprotein(a) have been found to be very useful to assess risk.

19040750_mLDL-P measures the actual number of LDL particles (particle concentration). LDL-P may be a stronger predictor of cardiovascular events than LDL-C. Low LDL-P is a much stronger predictor of low risk than low LDL-C. In fact, about 30 – 40% of those with low LDL-C may have elevated LDL-P. Therefore you can have low LDL-C but still be at risk for heart disease, particularly if your LDL-P is elevated. Discordance is considered present if LDL-C differs from LDL-P.

LDL-C is a measure of the cholesterol mass within LDL-particles. LDL-C only indirectly reflects the atherogenic potential of LDL particles. ApoB and LDL-P on the other hand reflect the number of atherogenic particles, with no mention of cholesterol mass. ApoB and LDL-P are believed to be better risk predictors than LDL-C.

Many recent studies have looked into the importance of LDL-particle size. Studies show that people whose LDL particles are predominantly small and dense, have a threefold greater risk of coronary heart disease. Furthermore, the large and fluffy type of LDL may be protective.

Sometimes it is difficult to understand the difference between LDL-C and LDL-P and how particle size comes into the picture. It is quite likely that LDL particle number and size will be used more often in the future to assess risk. Therefore I decided to share with you four slides I often use to simplify these issues. In the slides LDL lipoprotein is presented as trucks carrying sand (cholesterol).

Hope you enjoy the slides although you may find my chemistry to be on preschool level.




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Roger Butler
6 years ago

As someone who’s own knowledge of chemistry is very much at the pre-school level I found this post and particularly the 4 slides extraordinarily helpful: Thank you.

Jerry White
Jerry White
6 years ago

Is the reason this is not used by most Drs yet is that there is no “pill” and thus no push from Pharma?

KV
KV
6 years ago

Hi, Dr. Sigurdsson. You’ve got a very nice blog going here, mainly because of its two primary features: there is your medical expertise which oversees it all, plus the fact that it is not all about one-sided advocacy (especially with the diversity of commenters). That said, I don’t think that you would deny that you have an obvious leaning toward low carb – though I’m not quite sure if you favor that approach for everybody or instead mainly for the insulin resistant. My aim is to try and discover what is best to do, so I have zero interest in… Read more »

Doc´s opinion
Admin
Doc´s opinion
6 years ago
Reply to  KV

Thanks KV. Appreciate your interest in my blog. Hope you continue visiting and feel free to share your thoughts 🙂

KV
KV
6 years ago

Hi, Jerry. Logically, the opposite would be true. As the result of advanced lipid testing, some people would get reclassified to a higher risk category. If those people cannot or will not lower their LDL-P through lifestyle changes, they might very well be put on statins and/or other meds. Statins do lower LDL-P – just generally not as much as they lower LDL-C. Apparently, niacin might also lower LDL-P (because it lowers triglycerides); but as far as I know the OTC fast-acting niacin is safer on the liver than the prescription slow-acting Niaspan. A standard lipid panel here costs around… Read more »

Glenn
Glenn
5 years ago

I’m a 54 year old male, 6’1″ and 225lbs. A recent physical revealed results that had my doctor prescribe statins. I have read very detrimental information and have resisted. Apart from the cholesterol numbers, I’m a picture of God health and eat a LCHF diet. Here are my numbers age results from a website that does a basic calculation: Your Total Cholesterol of 244 is HIGH RISK Your LDL of 162 is HIGH RISK Your HDL of 65 is OPTIMAL Your Triglyceride level of 85 is NORMAL RATIOS: Your Total Cholesterol/HDL ratio is: 3.75 – (preferably under 5.0, ideally under… Read more »

p stratos
p stratos
5 years ago

So…I know this is incredibly uneducated but how to I get large an fluffy from small and dense?

Axel F Sigurdsson
Admin
Axel F Sigurdsson
5 years ago
Reply to  p stratos

p stratos

It depends on many things. If you’re overweight or have metabolic syndrome you could target the TG/HDL-cholesterol ratio.

gaiusgracchus
gaiusgracchus
4 years ago

I’m guessing no one has read this study:
https://www.athero.org/commentaries/comm564.pdf

Gus Wrethman
Gus Wrethman
4 years ago
Reply to  gaiusgracchus

I am guessing you didn’t check to see her ‘donations’ or what the two companies that gave them, sell?

https://projects.propublica.org/docdollars/doctors/pid/355934

Maurice Daher
3 years ago

If anyone can help out, would be greatly appreciated… since I been on a Ketogenic Diet.. my Apolipoprotein B went up to 230, and my lipoprotein (a) is at 99, what am I doing wrong, am I consuming too much Saturated Fats.. is it the grass fed butter, or the Caprilic Acid C8 from Brain Octane…

Axel F Sigurdsson
Axel F Sigurdsson
3 years ago
Reply to  Maurice Daher

Maurice
Dietitian Franziska Spritzer wrote an interesting article on her blog explaining how her lipids, in particular LDL-C and LDL-P reacted to a LCHF/ketogenic diet https://www.lowcarbdietitian.com/blog/lipid-changes-on-a-very-low-carb-ketogenic-diet-my-own-experience
And a case report from some years ago
https://www.docsopinion.com/2013/07/24/low-carb-and-cholesterol/

Molly
Molly
3 years ago
Reply to  Maurice Daher

speaking from personal experience — my spouse can eat like you and his cholesterol and BP remain optimal. If I even look at a hamburger, mine goes up, it has never been optimal. It’s your genetics.
I eliminated all cheese from my diet and began taking Cholest-off (an OTC plant stanol), and now consume under 10 grams of saturated fat a day. Use Fitday.Com (it’s free) and you’ll see it. I got my numbers down and put off statins for another year. PS your ideal # goes down as you age. I’m 66.

Maurice Daher
3 years ago
Reply to  Molly

After major research, and read over 20 + books… I think I finally found an answer. that I am looking to get done this weekend… I think when the liver makes bile, the bile should be stored in the gallbladder (1L a day). but if your gallbladder has gallstones(cholesterol Stones) it prevents it from working properly and or holding enough bile to be used when you consume food, and specially fat.. I think thats why my cholesterol levels keep increasing dramatically every time I consume fat… and its taking a very long time to lower it… I will do a… Read more »

DN
DN
2 years ago
Reply to  Maurice Daher

Hi Maurice…any updates on this? Did the liver and gallbladder flush help with the cholesterol levels?

Thanks!

Maurice Daher
2 years ago
Reply to  DN

After the flush. Cholesterol LDL was a bit high but had gone down 20 points. So I increased my magnesium and vitamin c and only ate one protein meal a day with the secondary meal being 3 plates of cooked organic zucchini and 3 weeks and increased probiotics with every meal my cholesterol dropped from being as high as 10.3 down to 4.2 the doctor was shocked . So now for the past 4 weeks I increased the fats again to see if it was the fats or my gallbladder is clean and blood is stable.

trackback

[…] HDL (the “good”) cholesterol and changes the LDL from small to large, which is linked to a lower risk of heart disease (79,80, 81, […]

Jerry
Jerry
3 years ago

Dr. Sigurdsson, just came upon this site. It’s fascinating, thank you. I’m a 66 year old male who, until recently, thought he was pretty healthy. I always knew my total Cholesterol number was elevated-It’s currently 260. My doctors had always said though that the hdl/ldl ration was good and not to worry. So I didn’t worry. A recent series of tests including a CAT scan indicated that I have some moderate blockage in and a cardiologist wants to put me on statins. The calcium test has these numbers: Left main=34, Left Anterior Decending=61 Left Circumference=75 At this point i’m reluctant… Read more »

Axel F Sigurdsson
Axel F Sigurdsson
3 years ago
Reply to  Jerry

Hi Jerry The TG/HDL-C ratio is relatively benign suggesting that it’s unlikely that you have insulin resistance or a small LDL-pattern. https://www.docsopinion.com/2014/07/17/triglyceride-hdl-ratio/ Looking only at your lipid numbers I would probably not suggest statin treatment. However, your coronary calcium score is just above median for your age suggesting that you may be at slightly increased risk. Some doctors will recommend statins in this situation. But, although statins may reduce risk to a slight extent, healthy lifestyle is the most important thing in my opinion. Furthermore, some people experience side effects from statins. But, it’s a choice you have and should… Read more »

Jerry
Jerry
3 years ago

Dr., thank you for your speedy reply. As I seem to have, according to your own posting, moderate coronary artery disease: (“Coronary Calcium Score Interpretation Based on a number of studies, the following definitions are used to relate the coronary artery calcium score to the extent of atherosclerotic coronary artery disease: Coronary calcium score 0: No identifiable plaque. Risk of coronary artery disease very low (<5%) Coronary calcium score 1-10: Mild identifiable plaque. Risk of coronary artery disease low ( 400: Extensive atherosclerotic plaque. High likelihood of at least one significant coronary narrowing.”) A cardiologist said that I have coronary… Read more »

Ken
Ken
3 years ago
Reply to  Jerry

Jerry, Alex is not going to have your heart attack for you. You are. The cardiologist that told you about going on a Whole Food Plant Based lifestyle change (as low in all fats as possible- more a little later) is telling you the truth. In that way there is the possibility of decreasing the size of the atherosclerotic plaques already built up in you coronary arteries that are, quite literally, going to kill you if you don’t begin to take action soon. You don’t really have to worry about not getting enough protein as your body is very efficient… Read more »

Ken
Ken
3 years ago
Reply to  Jerry

Jerry, Alex is not going to have your heart attack for you. You are. The doctor that told you about going on a Whole Food Plant Based lifestyle change (as low in all fats as possible- more a little later) is telling you the truth. In that way there is the possibility of decreasing the size of the atherosclerotic plaques already built up in you coronary arteries that are, quite literally, going to kill you if you don’t take action. You don’t really have to worry about not getting enough protein as your body is very efficient with recycling the… Read more »

DN
DN
2 years ago
Reply to  Jerry

Hi Jerry, what side statin side effects are you worried about? I was a bit on the fence myself for years, however no diet helped lower cholesterol (in my case, it is genetic). I’ve been now taking for 7 or so years without any noticeable side effect.

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