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What Is Small, Dense LDL?

Small, Dense LDL May Raise Your Risk of Heart Disease Even More


Updated June 10, 2014

Few individuals who have experienced a heart attack will tell you that they were never diagnosed with high cholesterol. These individuals may have had a form of LDL that is more atherogenic, increasing their risk of heart disease: small, dense LDL.

What is Small, Dense LDL?

Having high LDL cholesterol, otherwise known as “bad” cholesterol, is not good for your heart health. However, more studies are now finding that it isn’t only the quantity of LDL circulating in your blood -– it’s the quality, too. The type of LDL in your body may influence your risk of having heart disease down the road. Small, dense LDL is a type of LDL cholesterol that is considered to be an emerging risk factor for cardiovascular disease. It is smaller and heavier than typical LDL cholesterol and can increase your risk of developing atherosclerosis.

Who Has Small, Dense LDL?

Anyone –- ranging from young adults to the elderly -- can be at risk of developing small, dense LDL particles. It appears that the development of small, dense LDL can be inherited, with incidence between 35% to 45%. Additionally, lifestyle can also play an important role in the formation of small, dense LDL. People at risk of developing small, dense LDL in the blood include:

Reducing the Formation of Small, Dense LDL

You can do some things to reduce the formation of small, dense LDL in the blood. While you cannot do much if you have inherited raised small, dense LDL, you can make some changes to your lifestyle. Ways you can lower your risk of small, dense LDL cholesterol formation include:
  • Lower your carbohydrate intake in addition to your saturated fat and trans fats intake.
  • If you have diabetes, get it under control by taking medication and following a healthy diet.
  • Lose weight if you are obese. This can be accomplished by following a diet low in fat and carbohydrates and moderate physical activity.
  • If you are already taking medication to lower your cholesterol levels, some of these drugs may also reduce the formation of small, dense LDL. These would include fibrates and niacin.
  • Know your risks of having heart disease in the future. Do you have a parent that had a heart attack at 40? If so, you may be at risk of developing heart disease at a young age, too.
Tests can measure small, dense LDL; however, it is not usually measured in a typical cholesterol test. These test include:

These tests can be fairly expensive and are not available at all medical facilities. While high levels of small, dense LDL can increase your risk of heart disease, its ability to cause heart disease independently of other factors (such as diabetes and high trans fat intake) has not been fully established. Because of these factors, The National Cholesterol Education Program does not recommend routine testing for small, dense LDL in health screenings.


Rizzo M, Berneis K. Who needs to care about small, dense low-dennsity lipoproteins? Int J Clin Pract 2007, 61, 11, 1949–1956.

Backes J. Effect of lipid-lowering drug therapy on small-dense low-density lipoprotein. Ann Pharmacother 2005; 39: 523-526.

Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (PDF), July 2004, The National Institutes of Heath: The National Heart, Lung, and Blood Institute.

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