LDL particle size - small dense vs. large fluffy

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LDL particle size - small dense vs. large fluffy

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Old 11-21-2016, 22:03   #1
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Default LDL particle size - small dense vs. large fluffy

Is having large LDL particles of less concern for CVD than the small dense?

Since this discussion began in another thread and was sort of off-topic, I thought it would be good to bring it into its own thread, as this is an important subject.

Originally Posted by Tracker View Post
I'd love to see some links to studies which confirm that fluffies are of no concern. I've not been able to find anything. Does anyone have any?
Originally Posted by Tracker View Post
It seems to me that this is a generally accepted theory (that high amounts of fluffies are of no concern) in many forums, but I've never (so far) seen this backed up by anything, so I thought I'd ask. My own LDL and particle count have been sky high for two years now, ever since going on LCHF, and it's very worrisome.!
Originally Posted by mbuster View Post
Didn't have time to go thru but maybe one of these hits may lead to something. I saw mention of "studies say" and hope they reference them.

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Old 11-21-2016, 22:19   #2
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It boggles my mind, that insurance companies are refusing to cover advanced testing. Finally they are getting something meaningful to their customers health and they say it is unnecessary and/or experimental. I know they are really saying its the cost to us, not your health, that is important to us. Now the labs my PCP was using have come back and said if you Mr Insurance aren't going to pay anything, we are going to quit writing off the difference. Really sucks, but I can't blame the labs.

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Old 11-21-2016, 22:33   #3
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Thanks for starting this thread, VeeJay!

As soon as I started on LCHF two years ago, my LDL-C and LDL-p, as well as ApoB, have exploded. My HDL and Triglycerides haven’t changed much (they were always very good).

I’ve tried to find studies over the course of the last two years that confirmed the theory that I’ve seen time and again on this forum and others that claims fluffies are harmless, and always came up empty.

Today, when googling "ldl particle size and cardiovascular risk" I found this link: http://www.athero.org/commentaries/comm564.pdf. I'm quoting from it (IMT means carotid "intima-media thickness", a direct and non-invasive measure of subclinical atherosclerosis):


Small LDL confounded the association of large LDL with IMT because of its strong inverse correlation with large LDL, which may underlie the widespread belief that large LDL confers less cardiovascular risk than small LDL. Contrary to current opinion, both small and large LDL were significantly associated with subclinical atherosclerosis independent of each other, traditional lipids, and established risk factors, with no association between LDL size and atherosclerosis after accounting for the concentrations of the two subclasses. This knowledge may contribute to our understanding of atherogenesis, and future studies examining LDL size and atherosclerosis should account for the significant inverse correlation between small and large LDL.

Since I never found studies that backed up the harmlessness of fluffies I’ve always been suspicious of that theory. Now that I’ve read that article I am more concerned than ever. Granted, this is perhaps the only article that comes to a negative conclusion and all the ones that confirm harmlessness haven’t been found by me yet. I sure hope I will find them, or someone else might.

If there’s anyone else having found anything about studies one way or another, please post!

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Old 11-21-2016, 22:48   #4
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And from this article Low-density lipoprotein size and cardiovascular risk assessment | QJM: An International Journal of Medicine this quote:

Therefore, it remains debatable whether to measure LDL particle size in cardiovascular risk assessment, and if so, in which categories of patients. In several studies, therapeutical modulation of LDL particle size or number has been of great benefit in reducing the risk of cardiovascular events, but a no clear causal relationship has been shown, due to confounding factors, including lipid and non-lipid variables. Additional studies are needed to investigate the clinical significance of LDL size measurement.

I could spend hours on researching this, only to find that ultimately, this subject is so incredibly complex that nobody knows anything for sure. And here we hyperlipidemiacs, who don't want to go on statins and/or would love to know their risk, are, and at a loss how to deal with our crazy lipids...

Last edited by Tracker; 11-21-2016 at 22:50.
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Old 11-22-2016, 00:53   #5
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And then there's the thinking that high HDL levels are good for you, and possibly compensate for high LDL. That was my hope, with an HDL of 111. But then I saw this: https://www.statnews.com/2016/10/31/hdl-cholesterol/ Who knows what's wrong or right...

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Old 11-27-2016, 05:31   #6
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Not looking to gore anybody's oxen or upset any hobby horses, but I'm beginning to think the whole lipid thing is a crock. I have refused statins because the bad lipids/heart attack link seems tenuous, while the adverse side effects of the meds are very real.

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Old 11-27-2016, 12:27   #7
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Perhaps this has distracted us from the fact that LDL is a REALLY crappy predictor of CVD risk in the first place, "fluffy" or not!

Many have expressed that triglycerides are probably more important and that the TriG/TotC or the HDL/TriG ratios may be much better predictors.

Here's the thing: both of those nearly always improve dramatically on LC/HF. And here's another thing: they correlate very well with LDL particle size. In fact, low TriG and high HDL is considered a "proxy" for LDL particle size, i.e., a cheaper way to estimate it.

So, larger LDL may or may not be causal. They may just strongly tend to correlate with other things that are predictive of CVD risk. Total LDL seems not to be anywhere near the top of that list.

One thing we do know about small, dense as opposed to large "fluffy" LDL is that they are OXIDIZED. The reason for this is that they have stayed in the bloodstream too long, wandering around with nowhere to go. Any way you look at it, LDL being all "large and fluffy" seems to point to a system which is functioning better and bodes well for better health.

On LC/HF after a couple of years and after some of the advanced tests along with the usual ones, my doctor removed any recommendations regarding lipids in spite of TotC=236; TotLDL=160. But my TriG had dropped below 60 (from 158) and my HDL had risen above 60 (from 34). My LDL particles tested "all Type A". For CVD risk, he removed the prior warning and wrote "Favorable".

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