When it comes to the size of cholesterol particles, the phrase “bigger is better” certainly applies. Believe it or not, even “bad” cholesterol may not carry all the same health risks if the particles are larger.

While you should always discuss any health concerns with your healthcare team, this article provides answers to common questions around cholesterol particle sizes and advanced cholesterol testing to help you feel more prepared to discuss it with a doctor.

Low-density lipoprotein (LDL) cholesterol is often referred to as “bad” cholesterol because it can build up on the walls of arteries raising the risk of heart attack, stroke, and atherosclerosis.

On the other hand, high-density lipoprotein (HDL) cholesterol is often called “good cholesterol” because it helps to remove LDL cholesterol from the blood.

There is not much research to suggest that the size of HDL particles impacts the risk of health conditions one way or another, but researchers have found a potential connection when it comes to the size of LDL particles and cardiovascular conditions.

Studies have shown that smaller LDL particles carry greater potential health risks, as they are better able to penetrate the arterial wall. They have a longer circulation time to form more fatty masses.

While smaller, more dense LDL particles may pose additional risks, it’s important to note that all LDL particles can lead to arterial plaque, regardless of their size, and present cardiovascular risks.

The determination of particle size may impact treatment plans, as recent data shows statins and other therapies may not be effective in the management of elevated lipoprotein a (Lp(a)) levels and some can even increase the levels.

The ideal LDL levels for adults are less than 100 mg/dL. If your levels are above 130 mg/dL, they may catch your healthcare provider’s attention.

High levels of small LDL particles are frequently connected to elevated triglyceride levels and low HDL-C levels. This is often seen in individuals with metabolic syndrome or obesity. Another potential cause of heightened numbers of small LDL particles is insulin resistance, which increases your risk for developing diabetes.

As mentioned, a higher number of small LDL particles also carries cardiovascular risks because it is easier for them to invade the walls of the arteries and begin the process of arterial plaque formation.

When arteries are blocked, blood pressure typically elevates. It is also harder for blood to pass through with essential nutrients and oxygen.

If blood flow to the heart is reduced or blocked, it can lead to chest pain or a heart attack. Blocked arteries throughout the body can also lead to stroke, kidney failure, and poor circulation.

A basic cholesterol blood test, also known as a lipid panel or lipid profile, measures total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. It also measures particle sizes.

In some cases, LDL levels may not appear high, but there are a lot of LDL particles present. This can be due to the presence of many small particles or particles containing less cholesterol per particle.

LDL particle number testing looks at the precise number of LDL particles per liter of plasma and reveals the size of these particles.

Advanced testing for cholesterol

More advanced tests can also help determine cholesterol particle sizes and offer more information about the risk of heart disease due to LDL. Apolipoprotein B (apoB), LDL particle number (LDL-P), and lipoprotein A (Lp(a)) tests are three commonly performed advanced lipid tests.

ApoB testing measures the concentration of particles with apolipoprotein B on their surface. Because apoB is the main protein in LDL, this information can be used to help determine the risk of developing cholesterol-related heart conditions.

The American College of Cardiology now recommends checking Lp(a) levels at least once in a lifetime. Lp(a) levels are genetically determined, and have been found to be an independent casual risk factor for arteriosclerotic cardiovascular disease (ASCVD) and calcific aortic valve stenosis.

Medical opinions on the benefits of advanced cholesterol testing range. Advanced lipid testing may not be recommended or necessary if other risk factors are not present.

For many people, the information gained with advanced testing may not change the medical suggestions given. However, new gene therapies in development target certain small particles.

It’s a good idea to talk to your doctor about the potential benefits and the limitations of the information these tests can provide before undergoing one of these tests.

If advanced cholesterol testing is recommended by your doctor, the suggested frequency for this testing can vary depending on a number of factors like the extent of the cardiovascular conditions in your family history.

These tests can be performed at many healthcare offices or at a lab and involve a standard blood draw.

Your healthcare professional may suggest testing following your initial visit and at regular intervals throughout treatment or they may only recommend it once you have reached your goal LDL cholesterol levels.

The cost of testing can range from under $100 to over $1,000.

However, it may be at least partially covered by insurance. You’ll want to talk with your healthcare team and insurance company about what options to reduce the cost are available to you.

Large amounts of small LDL cholesterol particles can be concerning because of these smaller particles’ superior ability to penetrate arterial walls.

To test cholesterol particle sizes, you’ll need to do a more advanced form of lipid blood testing like apolipoprotein B (apoB), LDL particle number (LDL-P), or lipoprotein a (Lp(a)) testing if you wish to know more about the size of your cholesterol particles.

These particle levels can influence a tailored treatment approach with new research for gene therapies currently underway.