Lipoprotein Checklist: Small LDL

Small LDL

Just like people, LDL particles vary in size and structure. The size of the LDL particle makes a crucial difference in whether or not it contributes to coronary plaque.

While all LDL particles, regardless of size, contribute to heart disease and atherosclerotic plaque growth, small LDL particles are much more likely to do so. That’s because small LDL particles more readily enter and adhere to the artery wall, induce oxidative damage, and ignite inflammatory responses. Small LDL particles escalate heart attack risk up to 6–fold, as compared to large LDL.

Small LDL is more likely to be present when HDL is <60 mg/dl, though some people with high HDL levels may still have small LDL. Small LDL occurs with any level of LDL cholesterol, high or low. LDL cholesterol of 130 mg/dl, for instance, can be all large particles, all small particles, or, most commonly, some mixture of the two.

Because triglycerides are a necessary ingredient for the body’s production of small LDL, reducing triglycerides is among the effective strategies for reducing small LDL. Fish oil may work by this route.

Small LDL is much more common when pre-diabetic patterns are present, such as high blood sugar (≥110 mg/dl), low HDL, high blood pressure, large waist size, and increased inflammation (C-reactive protein). However, a rare person may have small LDL cholesterol particles even when pre-diabetic patterns are not present and body weight is ideal. This represents a strong genetic tendency that may not fully respond to treatment. Thankfully, this is unusual.
The majority of people with small LDL particles enjoy a vigorous response to the following strategies.

Small LDL is reduced by:

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