Greyscale image of hearts with text bubble saying LDL particle size and density

Various molecules are counted and/or calculated when we do blood work. This article focuses on particle size and density of LDL-Cholesterol. For a recap of LDL-cholesterol, please click here.

For a reminder about HDL cholesterol, please click here. And for a reminder about triglycerides, click here.

What is LDL-Cholesterol

LDL stands for low-density lipoprotein, which carries cholesterol (among other things) around the body. LDL serves an important role, as cholesterol is crucial for health. Click here to learn more about cholesterol.

This video summarizes how cholesterol and LDL carriers work.

Click here for a reminder of what HDL-C does.

LDL and Heart Disease

LDL is often considered ‘bad’, because its more related to cardiovascular disease. It’s more susceptible oxidation and inflammation. Oxidation and inflammation are the driving forces behind almost all chronic diseases [1], notably heart disease [2].

LDL Particle Size and Density

The total LDL-C count doesn’t tell the whole story – we need to focus on size and density of the LDL-C molecules.

We usually talk about Pattern A versus Pattern B LDL molecules. Pattern A is good; Pattern B is bad. That is, Pattern B is the one that raises heart disease risk. Keep in mind that these molecules exist in a continuum, and there will be some in between these two extremes.  About 25% of those with elevated pattern B inherit this trait, but diet, nutrition and exercise [3] all affect it too.

The image below depicts how LDL actually exists. There are various sizes of LDL molecules, and the smaller ones are more dangerous for our health. These can be tested.

Picture showing how LDL is classified based on particle size and density - large, fluffy pattern A or small, dense pattern B

There is a greater cardiovascular disease risk associated with Pattern B (small/dense) LDL versus Pattern A (large/fluffy) [4]. Fifty-percent of men with atherosclerotic cardiovascular disease have pattern B LDL; it is also seen more commonly in Type 2 Diabetes, insulin resistance syndrome, chronic anovulation, and PCOS [3].

Looking Beyond LDL-C to Assess Heart Health

In the past, many doctors would prescribe medications simply off a high LDL-cholesterol. New guidelines advise doctors to assess other factors and “physicians now have to shift their thinking away from only looking at cholesterol levels” [5].

To fully assess heart health, blood tests must be used in conjunction with blood pressure, blood sugar regulation, smoking, exercise, stress and family history. It is based on these factors (and more) that doctors should be basing their treatment decisions. It’s no longer acceptable for a slightly elevated LDL-C to warrant aggressive treatment, such as statins [5].

I can’t tell you what numbers you should aim for, because there are many factors that contribute to overall risk. Your primary care physician (naturopath or medical doctor) can determine your individual risk and then determine your optimal lipid numbers and subsequently the best treatment plan for you.


It’s true, LDL-C is associated with heart disease. However, the size and density of LDL molecules play an important role in determining risk. Large fluffy LDL molecules can actually be protective, while small, dense molecules carry more danger when it comes to cardiovascular disease.


Interested in learning more?

Read on in our series of articles on Heart Health!

About the Author - Dr. Johann de Chickera

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Dr. Johann is a fully licensed Naturopathic Doctor. His approach emphasizes the importance of living a healthy lifestyle and improving one’s health naturally. Dr. Johann obtained a Doctor of Naturopathy at the Canadian College of Naturopathic Medicine (CCNM). Education at CCNM is a vigorous four years, with a curriculum involving biomedical sciences, physical diagnosis, clinical nutrition, traditional Chinese medicine and acupuncture, botanical (herbal) medicine, physical medicine, homeopathy and lifestyle management.

While Dr. Johann has a general practice, he focuses on fertility, hormonal imbalances, gut health, and autoimmune disease.

To book in please call us at (519) 442-2206 or click here.

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