Lethal Lipids II

I call the combination of low HDL, small LDL, and lipoprotein(a) "lethal lipids," since the trio is an exceptionally potent predictor for heart disease. Uncorrected, the combination is a virtual guarantee of heart disease.

Ed is a perfect example of someone who came to my office recently with this pattern. His starting values:

HDL: 34 mg/dl

Small LDL: 78% of total LDL
NMR: Small LDL 1655 nmol/L; total LDL particle number 2122 nmol/L)

Lipoprotein(a): 205 nmol/L

The atherogenicity, or plaque-causing potential, of this pattern was reflected in Ed's heart scan score of 2133.

You can readily see that, of this combination, only HDL cholesterol would be adequately identified through conventional lipid testing. Small LDL and lipoprotein(a) need to be specifically measured via lipoprotein testing.

And, contrary to the drug industry's "statin drugs for everybody" motto, this pattern, while improved with statin therapy, is not shut off.

Specific correction of each abnormality is required. For instance, niacin addresses all three: increases HDL, reduces small LDL, and (usually) reduces lipoprotein(a). A standard low-fat diet makes this pattern worse by reducing HDL, increasing small LDL, and (usually) increasing lipoprotein(a).

Comments (7) -

  • Anonymous

    5/23/2009 4:12:16 PM |

    so what kind of diet should this person adopt?

  • karl

    5/23/2009 6:06:51 PM |

    He should eat low carb and take niacin and fishoil to start..

  • Anna

    5/24/2009 6:25:38 PM |

    Eating more natural fats including natural fats, like coconut oil and nutrient-dense fats ( pastured egg yolks and grass-fed butter especially), will raise his HDL, too.

  • Fran

    5/29/2009 2:23:50 AM |

    My husband's HDL was always in the 20's, a direct result of the low (to no) fat, low cholesterol diet recommended by most physicians. After much research and a NEW physician (ND) who recommended a low carbohydrate, high protein and adding good saturated fats, triglycerides dropped from 150 to 61 and HDL rose from 29 to 60. Small dense particles are moving in the right direction to large buoyant. We are what we eat and AHA has it all wrong.

  • Jessica

    5/29/2009 9:52:58 PM |

    There's an interesting post over at Musings of a Dinosaur regarding his likely decision to INCREASE use of statins...


  • Davide

    6/3/2009 1:04:05 AM |

    Dr. Davis,

    You're a busy guy--I know. But can you please do me the honor just answer this one question that bugs me to no end?

    If its the particle number and size of LDL that really matters, and (not the amount) then that means that dietary saturated fat has ABSOLUTELY NOTHING to do with heart disease; there is absolutely no connection between saturated fat intake and CHD. Is this correct?

  • Trinkwasser

    6/17/2009 12:45:49 PM |

    Well I'm not Dr Davis and nor are these guys but they say no


    Commentary here


    and here