Wednesday, October 22, 2008

LDL particle size

LDL stands for low density lipoprotein, a worthy protein that picks up cholesterol particles that have either been absorbed from your diet or manufactured by your liver and totes them out to the cells. And it's a good thing that we have LDL-C; our cellular membranes are made out of cholesterol as are our steroid hormones. But as you know, while a little LDL-cholesterol (LDL-C) is a good thing, a lot is not. In susceptible persons, excess LDL-C enters the arterial wall where it may become oxidized and set off a world of inflammation and cholesterol schmutz known as atherosclerosis.

Turns out, there's bad LDL-C and then there's really bad LDL-C, and the difference lies in the particle size. There's no improving on the metaphors of noted lipidologist Dr. Thomas Dayspring, so here's the scoop in his own words:

Large-sized LDL is a beach ball. It bounces off the artery and goes back to the liver. Small LDL is a bullet. It lacks vitamin E, is very prone to oxidation, and crashes right through the artery.

So how do you know if your cholesterol is bouncing or crashing? LDL particle size is measured in the pricey VAP test which stands for vertical auto profile, but the information is actually right there on your standardized lipid profile. If you've got triglyceride levels over 200 and HDL-cholesterol (that's high density lipoprotein or the good stuff) levels below 45 (35 for the guys) we're probably talking bullets in your bloodstream.

Any hope of changing bullets to beach balls? Well surprise surprise, it's the same old song as always--weight loss and exercise. But wait, there's drugs that help as well, including Tricor, gemfibrozil, niacin, and the diabetic medication metformin, Actos, and Avandia.


Anonymous said...

The VAP test is the vertical auto profile test.

femail doc said...

So it is, and thanks for the correction.

JeanMac said...

Does Crestor fit in the drug bracket, also, or is it used to stop production? Don't answer if it compromises you.

Anonymous said...

If small, dense LDL is the real culprit, why insist on still referring to LDL per se as 'bad' cholesterol when evidence indicates that large buoyant LDL is benign and not a risk factor? Also, before including a long list of drugs to convert 'bullets to beach balls' (good phrase by the way), it would seem preferable to mention dietary factors like improving Omega 6 to Omega 3 ratios.