LDL Particle Size
Lipids marker
LDL Size
LDL Particle Size
Category: Lipids
Unit: nm
Mean diameter of LDL particles. Pattern A (large buoyant, >20.5 nm) is less atherogenic; Pattern B (small dense, <20.5 nm) is associated with increased cardiovascular risk.
PED Notes
AAS shift LDL toward small dense Pattern B particles, increasing atherogenicity even when total LDL-C is not dramatically elevated. Oral AAS (stanozolol, oxandrolone) cause the most pronounced shift to small dense LDL. Insulin resistance from GH/insulin use compounds this shift. High triglycerides correlate with smaller LDL. Pattern B + elevated LDL-P is the most concerning combination.
Understanding LDL Size:
- Pattern A (>20.5 nm) = large buoyant LDL → lower cardiovascular risk
- Pattern B (<20.5 nm) = small dense LDL → higher cardiovascular risk
- Small dense LDL penetrates arterial walls more easily and is more susceptible to oxidation
If Small Dense (Pattern B):
- Reduce refined carbohydrates and sugar (primary dietary driver of small dense LDL)
- Omega-3 fatty acids shift LDL toward larger particles
Supplements:
- Omega-3 (EPA/DHA) -- 2-4g/day (shifts LDL to Pattern A)
- Niacin -- 500-1000mg/day extended-release (increases LDL size; use with caution, monitor liver)
- Citrus Bergamot -- 500mg 2x/day
Lifestyle:
- Reduce refined carbohydrates and sugar intake
- Regular aerobic exercise (most effective for shifting to Pattern A)
- If on oral AAS and Pattern B persists, consider discontinuing orals
References:
- El Harchaoui, K., van der Steeg, W. A., Stroes, E. S., et al. (2007). Value of low-density lipoprotein particle number and size as predictors of coronary artery disease. Journal of the American College of Cardiology, 49(5), 547-553. DOI: 10.1016/j.jacc.2006.09.043
- Ivanova, E. A., Myasoedova, V. A., Melnichenko, A. A., Grechko, A. V., & Orekhov, A. N. (2017). Small dense low-density lipoprotein as biomarker for atherosclerotic diseases. Oxidative Medicine and Cellular Longevity, 2017, 1273042. DOI: 10.1155/2017/1273042
- Mora, S., Otvos, J. D., Rifai, N., et al. (2009). Lipoprotein particle profiles by NMR compared with standard lipids in predicting incident CVD in women. Circulation, 119(7), 931-939. DOI: 10.1161/CIRCULATIONAHA.108.816181
History Chart
Reading History
Frequently Asked Questions
Reference Ranges
Standard Range
20.5 - 23 nm
VitalMetrics Range
19.8 - 23 nm