Small dense LDL Cholesterol

Optimal Result: 0 - 35 mg/dL.

Small dense LDL cholesterol (sdLDL-c) has been established to be highly associated with metabolic disorder.

Small dense LDL cholesterol (sdLDL-c), is a distinct LDL cholesterol subclass, which is associated with raised TG and decreased HDL-c levels in adiposity and diabetes, playing a distinct metabolic role in atherosclerosis.

The results of recent studies demonstrate that LDL fractions have different atherogenicity, with sdLDL being more atherogenic than larger LDL subfractions. sdLDL is characterized by the enhanced ability to penetrate the arterial wall that makes it a potent source of cholesterol for the development of atherosclerotic plaque. Importantly, longer circulation times of sdLDL result in multiple atherogenic modifications of sdLDL particles in plasma, further increasing its atherogenicity. Study of the sdLDL role in the development of atherosclerosis and CVD is hindered by significant variations in LDL fractionation results obtained by different methods.

Statins and other lipid-lowering drugs were reported to have beneficial effects on LDL profile correction, but more studies are necessary to draw clear guidelines for sdLDL lowering in CVD prevention and treatment. Although many questions regarding the efficacy of sdLDL reduction in CVD risk management remain open, there is accumulating evidence that sdLDL-C proportion is a significant marker for CVD prediction in many conditions associated with dyslipidemia.


Fan, J., Liu, Y., Yin, S. et al. Small dense LDL cholesterol is associated with metabolic syndrome traits independently of obesity and inflammation. Nutr Metab (Lond) 16, 7 (2019).

Ivanova EA, Myasoedova VA, Melnichenko AA, Grechko AV, Orekhov AN. Small Dense Low-Density Lipoprotein as Biomarker for Atherosclerotic Diseases. Oxid Med Cell Longev. 2017;2017:1273042. doi: 10.1155/2017/1273042. Epub 2017 May 7. PMID: 28572872; PMCID: PMC5441126.

Hirano T, Ito Y, Koba S, Toyoda M, Ikejiri A, Saegusa H, Yamazaki J, Yoshino G. Clinical significance of small dense low-density lipoprotein cholesterol levels determined by the simple precipitation method. Arterioscler Thromb Vasc Biol. 2004 Mar;24(3):558-63. doi: 10.1161/01.ATV.0000117179.92263.08. Epub 2004 Jan 15. PMID: 14726414.

What does it mean if your Small dense LDL Cholesterol result is too high?

Small dense LDL cholesterol (sdLDL-c), is a distinct LDL cholesterol subclass, which is associated with raised TG and decreased HDL-c levels in adiposity and diabetes, playing a distinct metabolic role in atherosclerosis.

Having a high level of small dense LDL cholesterol could mean that a person has a higher risk of developing potentially life threatening conditions, such as heart disease.

Small dense LDL (sdLDL) is an extremely atherogenic LDL subtype that is associated with about 3-times greater risk for CVD than normal-size LDL particles. SdLDL-C levels are also independently associated with increased risk for Type-II diabetes. SdLDL-C is associated with elevated triglycerides and low HDL-C (mechanistically), obesity, metabolic syndrome, pre-diabetes, insulin resistance, renal dysfunction, hepatic steatosis and dietary trans-fatty acids.

The level of sdLDL-C is not proportional to the level of total LDL-C. The sdLDL more readily penetrate the arterial endothelial wall and are more prone to oxidation. Elevated sdLDL-C may be lowered with lifestyle modifications and niacin that lower TG levels, as well appropriate control of blood glucose.

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