Large VLDL-P

What is VLDL?

VLDL stands for very-low-density lipoprotein. Your liver makes VLDL and releases it into your bloodstream. The VLDL particles mainly carry triglycerides, another type of fat, to your tissues. VLDL is similar to LDL cholesterol, but LDL mainly carries cholesterol to your tissues instead of triglycerides.

VLDL and LDL are sometimes called "bad" cholesterols because they can contribute to the buildup of plaque in your arteries. This buildup is called atherosclerosis. The plaque that builds up is a sticky substance made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, the plaque hardens and narrows your arteries. This limits the flow of oxygen-rich blood to your body. It can lead to coronary artery disease and other heart diseases.

A normal VLDL level is below 30 mg/dL. Your healthcare provider can measure your VLDL cholesterol through a simple blood test. If your VLDL is high, lifestyle changes and medication can help.

Due to their chemical structure, fats (like cholesterol and triglycerides) can’t travel solo through your blood. That’s why they need lipoproteins to carry them to various organs and tissues throughout your body.

The main job of VLDL is to carry triglycerides and cholesterol to the places that need them. In their transport role, VLDLs help your body gain energy, store energy and regulate blood pressure. So, they’re important for your overall body function. But having too many VLDLs in your blood can be dangerous and raise your risk of cardiovascular disease.

What are Large VLDL Particles (Large VLDL-P)?

Large VLDL particles, also known as very-low-density lipoprotein particles, play a significant role in lipid metabolism and cardiovascular health. VLDL particles are primarily composed of triglycerides, which are a form of fat. They also contain cholesterol, fatty acids, and a protein called apolipoprotein B (apoB). High levels of apoB in the blood have been associated with an increased risk of cardiovascular disease. When there is an excessive production of VLDL particles or impaired clearance from the bloodstream, it can lead to elevated levels of VLDL cholesterol. High levels of VLDL cholesterol are considered detrimental to cardiovascular health, as they contribute to the development of atherosclerosis, which is the buildup of plaque in the arteries. Atherosclerosis can restrict blood flow and increase the risk of heart disease, heart attack, and stroke.

Why do I need this test?

You may need this test if you are at risk for CVD. Risk factors for CVD include:

- Older age

- Gender–men are at higher risk

- Family history

- High blood pressure

- Obesity and overweight

- Sedentary lifestyle

- Diabetes

What other tests might I have along with this test?

You may also need these other tests at the same time to check your cholesterol levels:

- Total cholesterol

- LDL (bad) cholesterol

- HDL (good) cholesterol

- Triglycerides

You may also need these tests:

- Electrocardiogram (records the electrical signal from the heart to check for different heart conditions)

- Stress test (shows how the heart works during physical activity)

- Echocardiogram (uses sound waves to show how blood flows through the heart and heart valves)

- Cardiac catheterization (a procedure to examine how well your heart is working)

What are lipoproteins?

Low-density lipoproteins (LDL) and very low-density lipoproteins (VLDL) are two different types of fatty substances found in your blood. They carry cholesterol and triglycerides through your bloodstream. Cholesterol is a fatty substance that is necessary for building cells. In the body, it’s most commonly created in your liver. 

What are Triglycerides?

Triglycerides are another type of fat that’s used to store extra energy in your cells. 

Is it VLDL or VLDL-C?

Most people use “VLDL” and “VLDL cholesterol” interchangeably. But there’s a difference worth knowing.

VLDL refers to the lipoprotein, or the particle, that your liver creates. This particle transports fats and proteins in your blood. VLDL is a bit like a bus. The passengers on the bus include the different fats and proteins that need a ride. Cholesterol is one of those passengers. VLDL cholesterol refers to the cholesterol that’s carried on VLDL particles throughout your blood.

Other types of lipoproteins, like LDLs and HDLs, also serve as buses. They each carry different amounts and forms of fat and protein. LDL cholesterol refers to the cholesterol that LDL particles carry. Similarly, HDL cholesterol refers to the cholesterol that HDL particles carry.

What is the difference between VLDL and LDL?

Though VLDL and LDL share the same building blocks, these two types of lipoproteins differ in the percentages of the cholesterol, protein, and triglycerides that make them up. VLDL contains more triglycerides, while LDL contains more cholesterol.

VLDL and LDL are both considered carriers, and types of “bad” cholesterol. While your body needs both cholesterol and triglycerides to function, having too much of them can cause them to build up in your arteries. This can increase your risk for heart disease and stroke. One is not worse than the other, and they’re both equally atherogenic (meaning they promote atherosclerosis).

Most people will get their LDL-C and VLDL level tested during a routine physical exam. They are usually tested as part of a lipid panel.

What are the main components of VLDL?

All lipoproteins are made of fats and proteins. But the chemical makeup differs based on the specific type of lipoprotein. For example, each type of lipoprotein contains different amounts of fat and protein, as well as different forms of each. Researchers call VLDLs “triglyceride-rich lipoproteins” because of their high triglyceride content.

VLDL is created in your liver to carry triglycerides throughout your body. It’s made up of the following components by weight:

Main components of VLDL:

- Cholesterol 10%

- Triglycerides 70%

- Proteins 10%

- Other fats 10%

The role of VLDL in atherosclerosis:

When your liver produces more VLDLs than you need, your body has to metabolize them (break them down). Your body uses VLDLs to make intermediate-density lipoproteins (IDLs) and ultimately LDLs. These are important lipoproteins that your body needs. But, again, your body only needs so many. Excess LDLs in your blood can become trapped inside the walls of your arteries and promote plaque growth.

Research shows that the combination of high VLDLs and high LDLs is more dangerous than high levels of either of those alone. Plus, when your body breaks down VLDLs to make LDLs, some leftover bits remain. These “remnant particles” are made mostly of cholesterol. They’re small enough to get trapped inside your artery walls and promote atherosclerosis.

Why is atherosclerosis so dangerous?

Atherosclerosis is dangerous because it narrows your arteries and raises your risk for various forms of cardiovascular disease, including:

- Coronary artery disease.

- Cerebrovascular disease.

- Peripheral artery disease.

- Aortic aneurysm.

What are triglycerides used for?

The triglycerides carried by VLDL are used by cells in the body for energy. Eating more carbohydrates, or sugars, than you burn can lead to excessive amounts of triglycerides in the body and high levels of VLDL in your blood. Extra triglycerides are stored in fat cells and released at a later time when needed for energy.

High levels of triglycerides:

High levels of triglycerides are linked to the buildup of fatty deposits in your arteries. These deposits are called plaques. Plaque buildup increases your risk for heart disease and stroke. Experts believe this is due to:

- increased inflammation

- increased blood pressure

- changes in the lining of blood vessels

- low levels of high-density lipoprotein (HDL), the “good” cholesterol

High triglycerides are also associated with metabolic syndrome and nonalcoholic fatty liver disease.

How often shall I have my cholesterol levels checked?

The American Heart Association recommends all individuals over the age of 20 get their cholesterol checked every four to six years. Cholesterol levels may need to be followed up more frequently if your risk for heart disease is high or to monitor any treatment.

Sources:

https://www.cdc.gov/cholesterol/cholesterol_screening.htm

References:

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Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73(24):e285-e350. PMID: 30423393 www.ncbi.nlm.nih.gov/pubmed/30423393.

Robinson JG. Disorders of lipid metabolism. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 195.

Balling M, Afzal S, Varbo A, Langsted A, et al. VLDL Cholesterol Accounts for One-Half of the Risk of Myocardial Infarction Associated With apoB-Containing Lipoproteins. (https://pubmed.ncbi.nlm.nih.gov/33272366/) J Am Coll Cardiol. 2020;76(23):2725-2735. 

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