LDL particle size is a more predictive marker of cardiovascular risk than LDL cholesterol number alone.

“so why is it that smaller particles are more often associated with a poor phenotype because when you have smaller particles you generally have more of them”

“what's bad about the LDL is that the LDL traffics that cholesterol into the artery wall where it will get retained and oxidized and lead to the process of atherosclerosis”

“what's bad about the LDL is that the LDL traffics that cholesterol into the artery wall where it will get retained and oxidized and lead to the process of atherosclerosis”

“So they hang around longer, and that may be one of the more important reasons that they're bad, is not because, partly because of the binding to the artery wall, the oxidation, all of that is important, but the fact that they're circulating so much longer gives them much more opportunity to interact with the arteries and undergo transformations that can be pro-inflammatory themselves.”

“But what it turned out is that within these particle profiles that we were studying, the highest risk was related to particles that actually have less cholesterol in them. So it led to kind of a rethinking of the role of cholesterol, not that cholesterol is not relevant to heart disease. In fact, it's cholesterol that goes up in the arteries. The question is, how does it get there? And it turns out that, even though these smaller particles carry less cholesterol, they do have a greater tendency to wind up in the artery wall. They can be bound more tightly to artery tissue. And once they get into the arteries, they tend to stick, and they tend to be oxidized more rapidly.”

“And that is people with a higher heart disease risk and people who have evidence of heart disease tend to have more of the particles that are smaller and more dense particles. And those individuals that are more healthy tended to have more of the larger, more buoyant LDL.”

“It's the small LDL particles.”