standard panel can’t differentiate between the two scenarios.
The good news is that we now have a test to measure the
total number of vehicles on the road, and we consider it an
invaluable tool. The bad news is most doctors don’t know
about it, and not all insurances will cover it.
LDL particle number, or LDL-p, can be attained with a
test called an NMR (nuclear magnetic resonance) lipid
profile. LDL-p represents the total number of LDL particles,
or vehicles on the road in our highway analogy, which
research suggests is a better predictor of risk. And as with
our highway analogy, in the case of LDL-p, all else being
equal, a lower number is better.
As I’ve mentioned, cholesterol passengers all start out in
buses, as in the Highway B example. These buses are LDL
particles that are “large and fluffy” thanks to their many
passengers. As the particles drop off passengers, though,
they shrink to act more like cars, making them “small and
dense.” Now, in a healthy system, these smaller particles
would return to the liver for recycling before long.
However, this process can be disrupted by two maladaptive
scenarios—thereby leading to a bloodstream full of small
and dense particles. When this happens, your bloodstream
looks more like Highway A, which is a sign that your body
has a recycling problem.
In the first maladaptive scenario, LDL particles can be
damaged, due to either oxidation (a function of time spent in
the bloodstream and exposure to oxidative by-products) or