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Heart & Cardiology/Scared about my high LDL-P


Dear Dr. Ahmed,
I am a 46 yr old male and I am 6'1" 187lbs and I think I have a pretty healthy diet and exercise regularly.  For the last handful of years my LDL has been a bit higher than normal and my HDL could be a bit higher as well.  My PCP never wanted to put me on meds like statins but I requested I have the more intensive lipid blood draw done.  Below is my results along with my physicians comments.  I am so concerned about my LDL-P!  I really need your expert advice I what you would advise me to do.  Thank you so much!
PCP' comments:
Cholesterol is not terrible.
Based on Framingham risk factor calculation... You have a 1.8% change of heart attack in next 10 years.
Certainly too low for statin medication, but i would encourage you to exercise regularly and eat low sugar, red meat and trans fat diet.
We can recheck again in a year.

Component Results
Component   Standard Range   Your Value
LDL PARTICLE Number, NMR   < 1000 (F1) nmol/L   1611
Reference Ranges (Percentiles)(F1)
Low (<20th percentile) < 1000
Moderate (20th to 49th percentile) 1000 - 1299
Borderline High (50th to 79th percentile) 1300 - 1599
High (80th to 94th percentile) 1600 - 2000
Very High (>95th percentile) > 2000

Small LDL Particle, NMR   <= 527 (F2, F3) nmol/L   609
Reference Ranges(F2)
Low < 117
Moderate 117 - 527
Borderline 528 - 839
High >839
Cholesterol, Total   <200 mg/dL   178
LDL Particle Size, NMR   > 20.5 (F2, F3) nm   20.9
Large HDL Particle, NMR   >= 4.8 (F3) umol/L   6.6
Large VLDL Particle, NMR   <= 2.7 (F3) nmol/L   <0.8
Triglycerides   <150 mg/dL   76
HDL Cholesterol   >=40 mg/dL   43
LDL Cholesterol   < 100 (F4) mg/dL   120
Reference Ranges (F4)
Optimal < 100
Near Optimal 100 - 129
Borderline High 130 - 159
High 160 - 189
Very High >= 190
LDL-C is inaccurate if patient is nonfasting.
HDL Size, NMR   >= 9.2 (F3) nm   9.1
VLDL Size, NMR   <= 46.6 (F3) nm   37.3
HDL Particle No, NMR   >= 30.5 (F3) umol/L   27.7
LP Insulin Resist Score, NMR   <= 45 (F3)   <25
(F1) Reference population comprises 5,362 men and women not on lipid
medication enrolled in the Multi-Ethnic Study of Antherosclerosis
Mora et al. Athersclerosis 2007.
(F2) Small LDL-P and LDL Size are associated with CVD risk, but not
LDL-P is taken into account.
(F3) Reference intervals shown are the 50th percentile of the
reference population comprising 4,588 men and women without known CVD
diabetes and not on lipid medication. Small LDL-P, LDL Particle Size,
HDL-P, Large VLDL-P, VLDL Size, HDL Size, HDL Particle, and LPIR score
been validated by LipoScience but not cleared by US FDA; the clinical
of these test results has not been fully established
Performed at: Liposcience
2500 Sumner Blvd., Raleigh, NC 27616
General Information
03/23/2015 2:15 PM
03/28/2015 4:03 AM

Final result


I want to provide some reassurance – you have very little to worry about. I understand that you are worried about your LDL-P (LDL Particle), as opposed to your LDL-C (LDL Cholesterol). LDL-P is not generally used in the US or Europe to assess cardiovascular risk. Multiple articles relating lipoprotein particles to the risk of cardiovascular disease have been published, but conclusions have contradicted each other and there is great disagreement among investigators (specifically see and It is possible that, in the future, a superiority of LDL-P over LDL-C will be found, validated, and then make its way into global cardiovascular risk assessments, but that day has not arrived yet. Until that time, we have to rely on the already tested and proven methods for cardiovascular risk stratification.

There is an improved cardiovascular disease risk estimator that is recommended over the Framingham Risk Calculator, and it can be found here:

Based on the information you have provided (and assuming some normal values), your 10-year cardiovascular disease risk is only 2.0%, not high enough to justify starting a statin medication. This confirms your PCP’s recommendations.

Patients with high levels of triglycerides and low HDL-C are likely to have high LDL-P despite normal or low LDL-C. However, you don’t really fit that profile. Because of that, I would still place you in a low cardiovascular risk category despite your somewhat high LDL-P.

The next question would be recommendations to lower LDL-P. Although statins do lower LDL-P, so do omega-3 fatty acids, exercise, and a Mediterranean and low carbohydrate diet. Here are my following lifestyle changes for improving overall cardiovascular health:
1. Adhering to a heart-healthy diet (the Mediterranean Diet or The Balanced Diet from NHS)
2. Regular exercise habits (stay physically active for at least 150 minutes at moderate intensity or 75 minutes at vigorous intensity each week)
3. Maintenance of a healthy weight (BMI <25)
4. Avoidance of tobacco and alcohol products

Hope that was helpful,  

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Mustafa Ahmed MD


Cardiology, Interventional Cardiology, Cardiac Surgery, Hypertension, Pulmonary Embolism, Structural and Valve Disease


Board Certification Internal Medicine and Cardiology Interventional and Structural Cardiology


Multiple Publications In High Quality Peer Reviewed Journals. Internationally Recognized.

MD from The Royal Victoria University of Manchester, England Medicine, Cardiology, Interventional Cardiology, Research Training - University of Alabama

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