HDL and LDL has been measured and used as a marker for atherosclerosis for a number of years, and the public’s understanding of it is quite superficial. They know of “bad” cholesterol, LDL, and “good” HDL, with little to no knowledge of particle size. With recent technology improvements, along with better testing, lipid profiles have been more closely examined and better understood to the particle size difference. Subclassing the lipoproteins and particle sizes gives a better analyze of the coronary risk and therapeutic strategies 1. Smaller sized LDL’s are the true “bad guys” in this situation, as they are much more atherogenic than the large sized LDLs, as they penetrate the arterial wall more effectively, more oxidative and higher binding to scavenger receptors1. HDLs are known to be a “negative risk factor” when elevated, as the larger HDLs are inversely related to incidents of MI and angina. The small HDLs are only subclass used to predict for CAD, when patients take statins 1. These are positive things to know and understand, so that physicians can help treat patients effectively. Physicians can also use this knowledge to educate patients, so that the general public understands and can differentiate between what is health and not, rather than a simple “good vs bad” level of understanding.
Rosenson, R. Clinical role of LDL and HDL Subclasses and apolipoprotein measurements. ACC current journal review. 2004.