Cholesterol particle size: LDL predominating as
very small & dense particles (LDL pattern B) is likely risky5
(LDL pattern phenotype B...the "polydisperse
pattern" [wide range of LDL particle sizes]). "LDL pattern
B" is an independent risk marker...elevated risk even if all other factors normal, risk being 3x
normal if predominating in the normal range & 6x if elevatd LDL with
pattern B6. Proton nuclear magnetic resonance spectroscopy (NMR) lipoprofile:
This measures amounts & sizes of particles in LDL and HDL3
and identifies 15 different profiles. The technical invention by
biochemist, James D. Otvos, is exclusively licensed through Lipomed,
Inc. of Raleigh, N. C. Size can also be reliably measured with
ultracentrifugation, HPLC, PGGE (NDGGE), and PTGE...this latter method
being explored for use by our lab.
Lots of large VLDL particles are risky3 [or is it
the small VLDL particles..."VLDL remnants"?5].
"LDL pattern B"
types often have low HDL6 (<35...maybe even <40 for males &
<50 for women5), slightly elevated triglycerides
(150-250, maybe even also 250-5005); and when so,
if5 total LDL is elevated (<1305),
may be referred to as the "atherogenic lipoprotein phenotype5"
(if this pattern but total cholesterol & total triglyceride are in
normal range= "atherogenic dyslipidemia"5)...and
these have an increased
tendency to coronary vasospasm6 (may have a prevalence as high as 33% of
males and 14% of females).
This group progresses most rapidly; and, once having heart disease, the
progression is twice the rate of other settings6. But,
this group responds best to treatment6.When atherogenic dyslipidemia is added to hypertension, insulin
resistance (the most sensitive test for insulin resistance is elevated fasting plasma insulin level), and procoagulant (hypercoagulable) state= "the
metabolic syndrome"5. When you have a combination
of "LDL pattern B", elevated APO-B, and elevated resting plasma insulin
levels, your cardiac risk is 20x normal! Treat pattern B with diet, exercise, and niacin (niacin increases
There are LDL droplets smaller than pattern B,
such as IIIa, IIIb (these two associated with carotid artery disease), and
the even smaller IVb (may be associated with plaque instability)6.
You could have 50% "LDL pattern A" larger particles and 30% or
more in the IIIa/IIIb range, you are at increased risk (anything greater
Sizing by NMR is an expensive test...$300 to upwards of $600.[Liposcience
file] [Berkeley HeartLab]