As knowledge of the health effects of cholesterol expands, new information has shed light on this perennial health issue. Smaller particles of low-density lipoprotein, or LDL, cholesterol are now thought to be more likely to cause atherogenesis --- plaque deposits in the linings of arteries --- than larger LDL particles. Treatment for small, dense LDL particles may vary and include a combination of medication and lifestyle changes.
Statins
Statins may not be the most appropriate therapy for reducing small, dense LDL cholesterol, according to a study published in the 2010 "Texas Heart Institute Journal." Participants in the study, with an average age of 61, took statins and showed a decrease in total cholesterol, LDL cholesterol and apolipoprotein B --- the main protein component of LDL cholesterol --- compared with a control group that did not receive statins. However, levels of small, dense LDL were approximately 4 percent higher in the statin group; and the proportion of buoyant LDL --- believed to be less prone to causing atherosclerotic plaques --- was approximately 7 percent lower. By raising the levels of the more dangerous small LDL particles and lowering the levels of the larger, less dangerous LDL particles, the researchers concluded that statins may increase the risk of atherosclerosis.
Weight Loss & Metabolic Syndrome
Weight loss decreases levels of small, dense low-density lipoprotein in some men, but not others, say researchers of a study published in the January 2011 "Obesity" journal. In the study, overweight men with either small, dense LDL or larger LDL cholesterol were put on weight-reducing diets for nine weeks. Some of the men's cholesterol levels in the small, dense LDL group converted to a greater proportion of larger LDL cholesterol particles. However their respiratory quotients --- a measure of the efficiency of energy usage --- increased, indicating a conservation of energy and less fat burning. The researchers concluded that weight loss may decrease the levels of small, dense LDL but increase other risk factors, such as an impaired ability to metabolize fats.
Typical conditions of those with excess belly fat, metabolic syndrome and fatty liver may also increase risk for higher levels of small, dense LDL particles, according to a study published in the March 2010 "Diabetology and Metabolic Syndrome." In the study, proportion of small, dense LDL particles in men with metabolic syndrome was higher than those without it and lower than those who had both metabolic syndrome and fatty liver disease. Participants with both metabolic syndrome and fatty liver also showed higher rates of atherosclerosis than in the other groups.
Treatment
Treating these conditions may require lifestyle changes and medications, depending upon the specific needs of each person. The American Heart Association recommends losing weight, increasing physical activity and decreasing intake of trans fats, saturated fats and dietary cholesterol to reverse metabolic syndrome and associated elevated cholesterol levels. The Cleveland Clinic outlines a 12-week program of therapeutic lifestyle changes, after which cholesterol-lowering medication may be added, as needed, to bring cholesterol levels within acceptable parameters.
Antioxidants
The antioxidant superoxide dismutase may be helpful in treatment of small and dense LDL particles, say authors of a study published in the October 2009 "Revista Medico-chirurgicala a Societii de Medici si Naturalisti din Iasi" journal. In the tissue culture study, scientists added superoxide dismutase to arteries with high levels of small, dense LDL particles for one hour and observed significantly improved vasodilation and decreased dysfunction in the linings of the arteries. The researchers concluded that superoxide dismutase protected arteries from dangerous forms of cholesterol, including small and dense LDL particles.
References
- "Texas Heart Institute Journal"; Statins do not decrease small, dense low-density lipoprotein; C.U.Choi, et al.; 2010
- "Obesity"; Reversal of small, dense LDL subclass phenotype by weight loss is associated with impaired fat oxidation. P.W. Siri-Tarino; et al; 2011
- "Diabetology and Metabolic Syndrome"; Low-density lipoprotein particle size in hepatic steatosis and metabolic syndrome. D.S. Kim; et al; 2010
- "Revista Medico-chirurgicala a Societii de Medici si Naturalisti din Iasi"; The protective effect of superoxide dismutase on isolated human mammary arteries preincubated with triglyceride-rich remnant lipoproteins; .G. Savoiu ; et al; 2009
- University of Maryland Medical Center: Metabolic syndrome - Treatment
- American Heart Association; Metabolic Syndrome
