Size distribution of LDL particles (small vs large)
4 providers include this
Lipid Panel / Cardiovascular Health
Pattern A (large):>20.5 nm, Pattern B (small):<20.5 nm
LDL Particle Size refers to the diameter distribution of your LDL cholesterol particles, typically measured in nanometers (nm) and categorized into patterns. Pattern A indicates predominantly large, buoyant LDL particles (≥20.5 nm), while Pattern B indicates predominantly small, dense LDL particles (<20.5 nm). Some labs also identify Pattern I (intermediate). Measured via specialized testing including nuclear magnetic resonance (NMR), ion mobility analysis, or gradient gel electrophoresis, particle size provides insights into cardiovascular risk beyond standard cholesterol measurements.
Small dense LDL particles (Pattern B) are significantly more atherogenic than large buoyant particles (Pattern A) for several reasons:they penetrate arterial walls more easily, bind more avidly to arterial wall proteoglycans, are more susceptible to oxidation, have reduced binding to LDL receptors (remaining in circulation longer), and are associated with increased inflammatory response. Pattern B is strongly associated with metabolic syndrome, insulin resistance, high triglycerides, and increased cardiovascular risk.
While particle number (LDL-P or ApoB) is generally considered more important than particle size for risk assessment, the combination provides comprehensive information. An individual with high LDL-P and small particle size faces particularly elevated risk. Importantly, particle size is modifiable—triglyceride lowering through diet, weight loss, or medication consistently shifts the distribution toward larger, less atherogenic particles. Some clinicians debate whether particle size provides independent risk information beyond particle number and triglycerides.
| Range Type | Level | Significance |
|---|---|---|
| Pattern B strongly associated with metabolic syndrome | Provides insight into metabolic health and insulin sensitivity | Modifiable through lifestyle and therapy |
| Optimal LDL Particle Size Ranges | Standard:Pattern A (large particles ≥20.5 nm) | Functional/Optimal:Pattern A with average particle size >21.0 nm |
| Clinical Concern:Pattern B (small particles <20.5 nm) | Pattern A (large buoyant LDL) is associated with lower cardiovascular risk. Pattern B (small dense LDL) confers 3-7x increased risk in some studies. Pattern I is intermediate. Labs may report average particle size (nm), LDL peak diameter, or percentage of small LDL-P. Focus should be on achieving Pattern A with low particle number for optimal cardiovascular protection. | Lower Triglycerides |
| Reduce triglycerides below 100 mg/dL (optimally <70 mg/dL) through carbohydrate restriction, weight loss, omega-3s, or fibrate medications. Triglycerides are the strongest modifiable determinant of LDL particle size—lowering triglycerides consistently shifts distribution toward larger, less atherogenic particles. | Carbohydrate Restriction | Reduce refined carbohydrates and total carbohydrate intake, particularly in those with metabolic syndrome or insulin resistance. Low-carb diets dramatically improve particle size distribution, often converting Pattern B to Pattern A within weeks, even without weight loss. |
Achieve healthy body weight and engage in regular aerobic exercise (150+ minutes weekly). Weight loss of 5-10% and consistent exercise improve insulin sensitivity, reduce triglycerides, and shift particle distribution toward larger sizes. Resistance training also contributes to metabolic health.
Supplement with high-quality fish oil (2-4g EPA+DHA daily) or consume fatty fish regularly. Omega-3s reduce triglycerides and increase LDL particle size. Prescription omega-3s (Vascepa, Lovaza) provide higher doses for more pronounced effects.
For persistent Pattern B with elevated triglycerides, fibrate medications (fenofibrate) effectively reduce triglycerides and shift particles toward Pattern A. Often used in combination with statins (use fenofibrate to avoid drug interactions). Niacin also improves particle size but has fallen out of favor due to side effects.
Large particles (Pattern A) are protective and associated with lower cardiovascular risk;no adverse effects from having predominantly large LDL particles
Pattern A prevalence:optimal metabolic health, low triglycerides (<100 mg/dL), healthy body weight, regular exercise, low-carbohydrate diet, genetic factors
Clinical trials demonstrating that interventions reducing triglycerides—including diet, weight loss, omega-3s, and fibrates—consistently shift LDL particle distribution from small dense (Pattern B) to large buoyant (Pattern A).
Source:Superko, "Beyond LDL Cholesterol Reduction,"Circulation, 1996
Studies showing that low-carbohydrate diets rapidly improve LDL particle size distribution, converting Pattern B to Pattern A in many subjects within 4-12 weeks, independent of weight loss.
Source:Krauss et al., "Separate Effects of Reduced Carbohydrate Intake and Weight Loss,"American Journal of Clinical Nutrition, 2006
Analysis indicating that while particle size provides prognostic information, LDL particle number (LDL-P) may be a stronger predictor of cardiovascular risk. Optimal risk reduction requires addressing both—achieving low particle number with predominantly large particles.
Source:Mora et al., "LDL Particle Size and Coronary Events,"Journal of Clinical Lipidology, 2011
None
Source:None
| Provider | Includes | Annual Cost | Biomarkers |
|---|---|---|---|
 Superpower | ✓ | $199 | 100+ (150 with ratios) |
 WHOOP Advanced Labs | — | $349 | 65 |
 Labcorp OnDemand | — | $398 | 30+ |
| — | $486 | 40+ | |
| — | $468 | 83 | |
| — | $349 | 100+ | |
 InsideTracker | — | $680 | 54 |
 Function Health | ✓ | $365 | 100+ |
| — | $250 | 65 | |
| — | $495 | 70+ | |
| — | $895 | 100+ | |
| — | $1950 | 150+ | |
| — | $399 | 100+ | |
| — | $Varies | 75+ | |
| — | $190 | 100+ | |
| — | $99 | 50 | |
| — | $125 | 60 | |
| — | $199 | 50 | |
| ✓ | $499 | 120+ | |
| ✓ | $4188 | 80+ | |
| — | $375 | 85 | |
| — | $700 | 129 |
4 providers include this biomarker in their panels
This information is for educational purposes only and is not medical advice. Always consult with a qualified healthcare provider about your specific health needs.
