Many risk factors contribute to the development of heart disease.
LDL cholesterol level is often used to determine whether preventative treatment is needed, such as medication to lower LDL, in an effort to prevent heart disease. However, research indicates LDL cholesterol alone is not necessarily a good determinant of risk. LDL particles vary in their content, size, and density. Not all LDL particles influence heart disease risk the same way.
Light, fluffy versus small, dense LDL particlesLDL particles come in** two main sizes**: Large, fluffy particles and small, dense particles.
Picture dump trucks on a highway. The large, fluffy particles are five large trucks transporting a full load. Now add 20 small trucks with a full load, to stand in for small, dense particles. It takes twenty small trucks to carry the same load five large trucks can transport.
The more “trucks” (that is particles) in your system, the greater your heart disease risk.
Hence the reason it is beneficial to have large, fluffy particles that can carry a lot in fewer loads versus smaller, denser particles that require more to carry the same load.
LDL-P: Particle concentration
Standard cholesterol lab work measures LDL cholesterol (LDL-C), the amount of cholesterol contained within LDL particles.
LDL-P measures the actual number of LDL particles. Research shows LDL-P to be a stronger predictor of heart disease than LDL-C. Individuals with a low LDL-C can still have elevated LDL-P. Therefore, standard cholesterol screenings may indicate you are not at risk when you actually do have a risk factor: elevated LDL-P. This is an unknown unless you look beyond standard cholesterol lab work.
If you have a large number of small, dense particles, your risk for developing heart disease is elevated, even if LDL-C remains within normal limits.
How to reduce small, dense LDLs
Lower triglycerides if they are elevated. The higher your triglycerides, the greater level of small, dense LDL cholesterol you will have. The lower your triglycerides, the more large, fluffy LDL you will have.
Reducing the amount of simple sugars and alcohol in your diet are two steps you can take to lower triglycerides.
Exercise directly influences LDL metabolism and particles. Increase your physical activity level and stick with it. Positive changes to particle sizes from exercise are not permanent and will “go away” within two weeks of ceasing activity. Studies find exercise duration to be a greater factor than exercise intensity. Add 20-30 minutes of exercise to your daily (or almost daily) routine for positive, long term improvements to LDL particle size.
Discuss niacin supplementation with your doctor. Niacin has been used to effectively raise HDL cholesterol levels and research suggests niacin can lower LDL-P.
It’s important to note statin medication does not decrease small, dense LDL levels. Just because you lower LDL-C to normal levels with statin treatment, your risk for heart disease may remain elevated if your LDL-P is above normal.
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