Small dense low-density lipoprotein (LDL) cholesterol is a type of potentially harmful cholesterol protein. It can increase a person’s risk of heart disease if they have too much of it.
Small dense LDL cholesterol is one of two proteins that carry cholesterol to and away from the body’s cells. The
This article will explain what small dense LDL cholesterol is and compare it with other types of cholesterol. It will also explain the healthy ranges for small dense LDL cholesterol and provide information on how to reduce small dense LDL formation.
The
However, people can also consume dietary cholesterol from the food they eat. This elevates the amount of cholesterol they have in their body.
For example, LDL cholesterol can build up in the blood vessels when a person’s level of this substance is too high. This clogs the arteries, increasing the risk of heart attack, stroke, high blood pressure, and similar heart health problems.
Clogged arteries make it harder for the heart to pump blood throughout the body, so high LDL cholesterol and the clogged arteries it causes may also cause chest pain.
The body naturally produces all of the cholesterol it needs. This means that having a low LDL cholesterol level is not typically a problem, and a person does not need cholesterol from food to increase it.
There are different types of LDL cholesterol particles, depending on their size and density. Small dense LDL is the
Having fatty deposits in the blood means that a person may be at higher risk of developing certain conditions, such as:
LDL cholesterol is an umbrella term for lipoproteins with a density between
LDL cholesterol has different classifications depending on its density, including very low-density lipoprotein (VLDL).
The subclasses of LDL cholesterol that are the smallest are called small dense LDL. However, this classification method may not always be the same among all studies.
VLDL
HDL cholesterol is a type of
Some people call HDL cholesterol “good” because it is seen as cardioprotective. We often tolerate higher LDL if HDL is in a normal or high range.
Typically LDL, HDL, and triglycerides are measured on a lipid panel. VLDL cannot be measured but can be estimated from triglycerides. It is typically about 1/5 of the triglyceride level.
Having higher levels of LDL and VLDL cholesterol
- stroke
- high blood pressure
- heart attack
Many of the same behavioral factors that elevate the risk of heart disease can also raise cholesterol. These factors include smoking and eating a lot of trans fats.
However, cholesterol levels are complex, and it is possible for a person to lead a very healthy lifestyle and still have high cholesterol.
It is possible to have genetic factors that cause high LDL despite all lifestyle changes. This is called
Healthy ranges for cholesterol are as follows:
| Total cholesterol | LDL | HDL |
|---|---|---|
| under 200 millgrams per dl (mg per dl) | under 100 mg per dl | above 60 mg per dl |
At-risk ranges are as follows:
| Total cholesterol | LDL | HDL |
|---|---|---|
| 200–239 mg per dl | 100–159 mg per dl | 41–59 mg per dl |
Dangerous ranges are as follows:
| Total cholesterol | LDL | HDL |
|---|---|---|
| above 240 mg per dl | above 160 mg per dl | under 40 mg per dl |
New 2023 guidelines state that all patients should receive treatment to get LDL less than 100. For high risk patients, they now suggest an LDL of less than 55. Previously, the goal for high risk patients had been 70.
Some strategies that can
- avoiding trans fats and limiting foods high in saturated fat
- eating high fiber foods, such as fruits and vegetables
- maintaining or reaching a moderate body weight
- remaining physically active, if possible
- quitting smoking, if applicable
- avoiding excessive alcohol consumption or getting help to quit drinking, if applicable
A person should contact a doctor regularly for help managing chronic medical conditions. Some conditions, such as hypothyroidism, can increase the risk of high cholesterol.
People with high cholesterol should talk with a doctor about additional interventions. In some cases, making lifestyle changes may help. However, taking cholesterol-lowering drugs called statins may help lower cholesterol in people at high risk of heart disease.
If statin therapy is not enough, then patients can be given further treatment including ezetimibe or PCSK9 inhibitors to further lower LDL cholesterol.
There is
That said, many doctors and organizations no longer put a specific limit on the amount of cholesterol a person should eat.
Patients should be able to calculate their risk using the ASCVD risk calculator or discuss the risk calculator with their doctor. It will show risk with and without statin therapy and help patients decide if treatment is right for them.
Many people with high cholesterol, including high LDL cholesterol, have no symptoms. A person cannot determine their cholesterol level based on symptoms alone or on the absence of symptoms. Over time, however, high LDL cholesterol increases the risk of heart disease.
A doctor can measure a person’s cholesterol level with a simple blood test. They call this a lipid panel or lipid profile because it shows the levels of each type of cholesterol.
The
Learn more about what to expect during a cholesterol test here.
Having a high level of small dense LDL cholesterol could mean that a person has a higher risk of developing potentially life threatening conditions, such as heart disease.
Everyone needs cholesterol screenings, even if they are otherwise healthy. Working with a cardiologist or another healthcare professional may help people with high LDL cholesterol lower their risk of heart disease.
Importantly, adopting a heart-healthy lifestyle can improve everyone’s health regardless of their cholesterol level. So, taking steps to prevent high LDL cholesterol may offer long-term benefits.