Providing independent clinical excellence since 2005
LDL-C alone may miss important cardiovascular risk. This article explains why ApoB and small dense LDL often better reflect atherosclerotic burden, especially in metabolic disease and high visceral fat. It outlines practical lipid targets by risk category and shows how LDL-C:ApoB ratios can estimate dangerous particle patterns
Reducing saturated fat intake is known to lower “bad” cholesterol (LDL-C) and reduce heart disease risk, but responses vary widely between individuals. Research shows that genetics strongly influence how much LDL rises when people eat foods like butter, cheese, or fatty meats compared with unsaturated fats such as olive oil, nuts, and oily fish. Even on the same diet, LDL responses can differ by up to 1 mmol/L, reflecting genetic differences in intestinal cholesterol absorption and how efficiently LDL is cleared from the bloodstream.
Small dense LDL (sdLDL) is the most harmful form of “bad cholesterol.” It forms when the liver overproduces VLDL — often driven by visceral fat and high insulin levels. Visceral fat sits deep around the organs and feeds directly into the liver, causing early metabolic disruption long before blood tests detect it.
Small dense LDL (sdLDL) particles are the most atherogenic type of LDL. They are smaller and heavier, stay in the bloodstream longer and more likely to oxidise and enter artery walls. High sdLDL is typical of metabolic syndrome, diabetes, and high triglyceride states linked to visceral fat.Because sdLDL testing is specialised, the ApoB level and the LDL-C : ApoB ratio can be used to estimate particle size predominance:
Statins are a mind boggling biological 'ruse'. When this medication is taken orally, it causes liver cells to become deficient in essential cholesterol, so they respond by increasing the number of cell surface LDL receptors, thereby enhancing their capacity to extract LDL particles from the blood, significantly lowering circulating LDL levels. Statins remain the most effective and well-known way that doctors can lower LDL levels to prevent or treat coronary heart disease.
Being born with almost no circulating cholesterol (or reduction of LDL to zero by drugs) results in nothing except a zero-lifetime risk of atherosclerosis (or cessation and reduction in atherosclerosis).