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 other type is called high-density lipoprotein (HDL) cholesterol.

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.

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The liver makes blood cholesterol, which is a waxy, fatty substance that everyone needs in small quantities. It helps carry dietary cholesterol and fat to and from cells. It also plays an important role in the body’s ability to create hormones.

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 most atherogenic subtype of LDL, which means that it is more likely to leave fatty deposits in the blood.

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 1.006 and 1.063 grams per milliliter.

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 helps carry triglycerides, which are blood fats, throughout the body. Like LDL, it is also a dangerous form of cholesterol that can increase a person’s risk of heart health problems. Doctors do not usually measure a person’s VLDL level because having high LDL often means that a person has high VLDL as well.

HDL cholesterol is a type of beneficial cholesterol. This is because it binds to cholesterol then shepherds it to the liver. This enables the liver to filter it out of the body. Therefore, having a higher HDL level can correlate with lower LDL and VLDL levels.

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.

Learn more about the difference between VLDL and LDL here.

Having higher levels of LDL and VLDL cholesterol correlates with having a higher risk of cardiovascular disease, including:

  • 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 familial hypercholesterolemia.

Healthy ranges for cholesterol are as follows:

Total cholesterolLDLHDL
under 200 millgrams per dl (mg per dl)under 100 mg per dlabove 60 mg per dl

At-risk ranges are as follows:

Total cholesterolLDLHDL
200–239 mg per dl100–159 mg per dl41–59 mg per dl

Dangerous ranges are as follows:

Total cholesterolLDLHDL
above 240 mg per dlabove 160 mg per dlunder 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.

Learn more about healthy cholesterol levels here.

Some strategies that can help prevent LDL formation and high cholesterol include:

  • 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 not a clear correlation between eating high cholesterol foods and having high blood cholesterol. There is, however, evidence to suggest that eating high fat foods and high cholesterol foods generally correlates with a higher risk of heart disease.

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.

Learn about how to follow a heart-healthy diet here.

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 American Heart Association (AHA) recommends that all adults over the age of 20 years have their cholesterol checked every 4–6 years.

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.