Part 3: Cholesterol: Size Matters

Part 3: Cholesterol: Size Matters

In This Article


It will take some time for doctors and the general public to decompress from sixty years of conditioning that a high cholesterol reading on a blood test means an increased risk for heart disease.

While the total cholesterol number means little according to the new science, it is the size of your LDL and HDL cholesterol particles that matters. The notion that the LDLs are the bad cholesterol and that the HDLs are the good cholesterol is an outdated over-simplification, and often an inaccurate predictor of cardiovascular risk. (1) Yes, there are bad HDLs!

Both LDLs and HDLs come in different sizes. Contrary to popular thought, there are some bad HDLs and some good LDLs. It is actually quite simple. The large fluffy cholesterol HDL and LDL particles are good, and the small, dense, hard bb shaped HDL and LDL particles are bad. (1)

Fortunately, there are a handful of blood tests that will determine the size of your cholesterol particles. Ask your doctor for any of the following tests:

  • VAP (Vertical Auto Profile)
  • NMR Lipo-Profile Test
  • Lipoprint Test
  • Berkeley Lipid Particle Test
  • LPP (Lipoprotein Particle Profile)

Pattern A or Pattern B LDLs

These new blood tests determine whether most of your LDL cholesterol particles are Pattern A or Pattern B. Pattern A indicates that most of your LDL particles are large, fluffy and beneficial, like they should be. These LDL-A particles are not damaged by oxidation, which is the process that causes arterial plaque. A Pattern B cholesterol profile indicates that most of your LDL particles are small, dense, hard and damaging particles. The smaller and harder the particle, the more easily they can penetrate the arterial wall and cause inflammation. These are the real bad guys.

Not All HDLs Are Created Equal

Your cholesterol particle blood test will also tell you the size of your HDL particles. Remember, it is the HDLs that were considered to be the good cholesterols, but the National Institutes of Health revealed that simply raising HDL levels did nothing to protect against heart attacks, stroke or death. (1) It is not the overall HDL level that matters; it is their size that matters.

HDL-2 particles are large, fluffy, buoyant and beneficial particles that are resistant to the damage of oxidation. They support healthy arteries and reduce inflammation. The HDL-3 particles, while not completely understood, are undesirable ones. They are believed to be atherogenic (promoting the build-up of fatty plaque in the arteries) and inflammatory.

Lp(a) Cholesterol is the Most Harmful

The Lp(a) cholesterol particle, or the apolipoprotein(a), carries out arterial repair duties on damaged blood vessels. On one hand, the Lp(a) supports arterial health, but when more repairs are needed, they can accumulate and then oxidize and damage the arterial wall. It is the Lp(a) that is responsible for the build-up of arterial plaque and clot formation. (1) Lp(a) is considered the most dangerous particle and is a direct risk factor for heart disease. (1)

Other Blood Tests that Screen For Cardiovascular Health:

  • C-Reactive Protein (CRP) – an inflammatory marker and predictor of heart disease.
  • Homocysteine – an inflammatory marker and direct risk factor for cardiovascular health.
  • HbA1c – a 3-month average of blood sugar that measures glycation levels.

Stay tuned for the last article in this series on cholesterol, where I will show you a new way to read your blood test results!

Part 1 of this series on cholesterol: Writing Love Letters Lowers Cholesterol 

Part 2 of this series on cholesterol: Saturated Fats and Cholesterol Exonerated

Part 4 of this series on cholesterol“I Can’t Believe It’s Not Cholesterol!” A Better Way to Read your Results


  1. Sinatra, Bowden. The Great Cholesterol Myth. 2012. Fair Winds Press.

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Dr. John

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