Small LDL subclass particles cause plaque buildup to progress much faster because they enter the artery wall more easily than large LDL particles. A predominance of smaller LDL particles, referred to as Pattern B lipid phenotype, represents an atherogenic lipid profile that is associated with CVD.
Small LDL particles are typically seen in people with elevated triglyceride levels and decreased HDL-C levels (i.e. people with the metabolic syndrome, obese patients, patients with diabetes). Numerous studies have documented a link between small dense LDL particles and an increased risk of ASCVD (=Atherosclerotic cardiovascular disease).
Feingold KR, Grunfeld C. Utility of Advanced Lipoprotein Testing in Clinical Practice. [Updated 2019 Nov 5]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK355893/
The presence of small LDL subclasses has long been associated with increased CVD risk and progression of atherosclerotic disease. These smaller particles are associated with rapid uptake into the endothelium contributing to accelerated atherosclerosis. Research is finding that smaller, denser LDL particles can burrow themselves into arterial walls and build up plaque far more easily than larger LDL particles. That’s a key reason why people who have low total cholesterol levels and even low total LDL levels can still be at high risk of a heart attack. The smaller your LDL particles, the more susceptible you are to plaque growth.
Consult your medical professional before starting any lifestyle change or treatment plan.
People with high cholesterol should talk with a doctor about additional interventions. In some cases, making lifestyle changes may help. However, taking cholesterol-lowering drugs called statins may help lower cholesterol in people at high risk of heart disease.
- Address by diet and exercise.
- Address excess LDL-P or ApoB
- Consider therapies to address insulin resistance (e.g., Metformin)
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