LDL particle size: an important but underrated factor in cholesterol risk assessment

When discussing cholesterol, attention often focuses on total cholesterol and LDL cholesterol, commonly referred to as "bad cholesterol." However, an increasing number of studies indicate that the mere amount of LDL cholesterol does not tell the whole truth. The real risk may lie in the size and structure of LDL particles. This is where LDL particle size comes into play – and its significance may be greater than previously understood.

LDL cholesterol (Low-Density Lipoprotein) does not move freely in the blood, but rather within lipoprotein particles.These particles can be:

•  Large and "loose" LDL particles, which are less harmful

•  Small and dense LDL particles, which are clearly atherogenic, meaning they narrow the arteries

 LDL cholesterol value (LDL-C) indicates how much cholesterol is contained in LDL particles in total. LDL particle size and number (LDL-P) indicates how many particles are in the blood and what size they are.

Why is this important? Because two people can have the same LDL cholesterol value, but very different risk levels if one of them carries a lot of small and dense particles.

Research shows that small, dense LDL particles are:

•  More easily oxidized, making them toxic to blood vessels

•  More easily penetrate the walls of arteries, promoting plaque formation

• Often associated with low HDL levels and elevated triglycerides 

•  Increase the risk of cardiovascular diseases, even when LDL levels appear normal

In other words: the quality of LDL is often more important than the quantity. 

Low-grade inflammation (silent inflammation) exacerbates the effects of LDL in many ways:

• It increases LDL oxidation, making it particularly harmful to arteries

• Inflammation weakens the protective effect of HDL 

• At the same time, it affects metabolism, promoting the formation of small LDL particles

Small LDL particles combined with inflammation are a significant risk factor for heart disease – especially when this is not evident from mere blood test values.

Several lifestyle factors can lead to LDL particles becoming smaller and denser:

•  High intake of sugar and processed carbohydrates 

•  High triglycerides 

•  Low HDL cholesterol 

•  Overweight, especially in the abdominal area 

•  Insulin resistance and metabolic syndrome 

•  Low-grade inflammation and gut imbalance 

This explains why even a slim but inflamed or sugar-rich diet can lead to a poor cholesterol profile.

The good news is that LDL particle size can be improved (i.e., increased) naturally:

• This lowers triglycerides and reduces the formation of small LDL particles

• Especially omega-3 fatty acids (e.g., salmon, flaxseed, walnuts)

• Avoid trans fats and excessive saturated fat (animal products)

Especially beta-glucan from oats, which lowers cholesterol and improves lipid profile

• Aim for a daily intake of over 3 grams (e.g., one serving of Glucavena or 2-3 bowls of oatmeal)

• Aerobic exercise improves HDL levels and reduces triglycerides

• A weight loss of just 5–10% can affect the size of LDL particles

• Hormonal imbalance affects cholesterol and inflammation

Exercise not only affects cholesterol levels – but also the quality of LDL particles. Several studies have shown that exercise can increase the size of LDL particles and improve HDL function, even if LDL-C levels do not change significantly.

• Higher triglyceride levels

• Lower HDL levels

• Smaller LDL particle size

• Decreased insulin sensitivity

• Increased inflammation

1.  Aerobic exercise (e.g.Walking, running, cycling)

   • Reduces triglycerides and increases HDL cholesterol 

   • Important especially for reducing small, dense LDL particles 

   • Recommendation: at least 150 minutes of brisk exercise per week 

2.  Interval training (HIIT) 

   • Effectively improves insulin sensitivity

   • Reduces visceral fat and improves cholesterol profile

   • An effective way to quickly reshape LDL structure for the better 

3.  Strength Training 

   • Increases lean body mass, improves glucose metabolism

   • Can complement aerobic exercise in improving LDL profile

4.  Combination Training (aerobic + strength) 

   • Proven to be the most effective combination for improving both cholesterol levels and LDL particle size 

Beta-glucan is a soluble fiber derived from oats that:

•  Reduces LDL cholesterol by binding bile acids and increasing their excretion through the intestines

•  Reduces triglycerides, which promotes the formation of larger LDL particles

•  Acts as a prebiotic in the gut → supports good bacteria and reduces low-grade inflammation

• Produces short-chain fatty acids (e.g.butyrate), which positively affect cholesterol metabolism and insulin sensitivity

When combined with diet and exercise, beta-glucan can thus be a key factor in improving LDL profiles – both in terms of quantity and structure.

 LDL particle size is a significant but often overlooked factor in the risk of cardiovascular diseases. Small, dense LDL particles are clearly more dangerous than larger particles, and their impact is further exacerbated in the presence of low-grade inflammation.

Examining only LDL values does not provide the full picture.It is important to understand that lifestyle factors – particularly diet, exercise, weight management, and gut health – affect LDL particle size.

 Beta-glucan is one of the most researched nutrients that can help both lower LDL cholesterol and improve its structure – naturally and safely.