Somewhat weird lipid panel
 

Recently I had a bunch of blood tests done including an NMR lipid panel. Everything is great except for one number. The problem is that some people say that's the only number that matters.

The number is LDL-P, the number of LDL particles, which is 1905. That's officially considered to be "a lot" and puts me somewhere above the 95% percentile. I am aware that there are other people (like Jimmy Moore of the LLVLC fame) in the same situation with even worse numbers.

Other things are good: TG 51, HDL-C 80, LDL pattern A, small LDL-P is only 149, HDL-P is 37.1.

LDL-C is 160 which actually seems lowish for the particle number of 1900. My ApoB is 120 which also seems lowish for that LDL-P since each LDL particle has exactly one ApoB molecule. TC is 250.

I am eating nonspecific paleo-style, low-carb (but not VLC, I'm not usually in ketosis). My thyroid panel is normal, TSH is 1.2, free T3 is 3.3. My inflammation markers are low, CRP is 0.47. I don't have glucose problems, HbA1C is 4.9% and the NMR panel gave me the insulin resistance score of 6. I'm not actively losing weight. I doubt I'm copper-deficient as my Ceruloplasmin is 18 which is well within normal range.

So all in all I'm not terribly worried, but I still don't like that LDL particle number. Recent studies like MESA point to the LDL-P being a better predictor of CVD to the extent that once you account for it, other common predictors (like LDL cholesterol, LDL-C, or particle size) become insignificant.

Any ideas, comments, advice?

Well, I don't think any of us really know if it is anything to worry about. But we DO know that high triglycerides and low HDL are. So... it seems like you have lots of large fluffy LDL. I wouldn't worry about it. I'd rather have that the the other.

Well, no, we *really* don't know :-) but the point is to get a good estimate.

The MESA study claims that the LDL size doesn't matter. Of course it's only one (though a large) study and it didn't have hard endpoints, but it's evidence.

I agree that high trigs and low HDL would be pretty nasty to have, but my situation is different and I'm rather curious about the proper interpretation of it...

I have become less worried about the LDL-P after reading a post by Dr. Davis on how sensitive that marker is.
http://blog.trackyourplaque.com/201...-particles.html
My DH's first reading was in high 1800s, then a re-test after careful eating one week before brought it way down to moderate, this year's test is back up. With similar other good markers like yours, his doctor said just continue to "monitor".
Who knows? How valid is it if four crackers can skew the test?

That's a story to illustrate a point, that's not data.

Two things: first, in that story the person eats 40-50g of carbs a day. And on this amount of carbs his LDL-P is 1200, the story says. OK. Now he adds 4 crackers which are what, 10g of carbs or so? And his LDL-P spikes to 1800? I am sorry, I don't believe this story. Very very few (non-diabetic) people control their carb intake with the precision of plus-minus 10g a day. And the moral of the story is that if you eat 45g of carbs a day your LDL-P will be 1200, but if you eat 55g of carbs a day your LDL-P will be 1800? Ahem.

The second thing is that in my particular case the issue is the total number of LDL particles. Almost all mine are large, I have only about 8% of them as small particles. So, presumably, my intake of carbs is fine.

Also, there seems to be a fairly major debate (including between cardiologists) about whether particle size matters. I don't think we can confidently assert that large particles are harmless.