Cholesterol Subtypes Defined

Discover which kinds of cholesterol are most harmful to your health

It's common to hear generalizations such as “LDL is bad cholesterol, and HDL is good cholesterol.” But in reality, both LDL (low-density lipoprotein) cholesterol and HDL (high-density lipoprotein) cholesterol are far more complex. There are multiple subtypes of both, and some of those subtypes are good and some are bad. So, it‘s not just about how high your LDL cholesterol is. It's about what kind of it you have, and how much. The same goes for HDL cholesterol.

Large Particles Are Good, Small Are Bad, and Lp(a) Is Worst of All

Let's take LDL for example. LDL cholesterol particles can be large and buoyant or small and dense, and they're not created equal. It's the small, dense LDL particles that can readily enter compromised arterial walls and fuel the inflammatory process. The large buoyant particles are less apt to act in that way. So it stands to reason that having a greater number of small LDL cholesterol particles puts you at higher risk for heart disease than if your LDL cholesterol is mostly the larger, more buoyant type.

High levels of small LDL cholesterol is of particular concern when the blood also contains a lot of Lipoprotein(a), or Lp(a)—the most dangerous of the blood lipids. Lp(a) is a specific type of small LDL cholesterol particle that inflames the blood and makes it sticky—making it more prone to clotting.

Similarly, there are subgroups of HDL cholesterol—as well as significant differences in how efficiently they remove excess lipids. Just like LDL cholesterol, not all HDL cholesterol is created equal. You want to be high in the most functional HDL cholesterol subgroup, HDL2.

Determining Your Cholesterol Subtypes

All of this means that your basic total cholesterol reading really doesn‘t mean much unless it‘s exceptionally high. What truly informs you and your doctor of your risk is the type of cholesterol fraction patterns you have—large or small LDL, and high functioning or low functioning HDL.

But because standard blood lipid tests won‘t reveal this type of information, you need to ask your doctor to order one of the newer generation cholesterol tests, such as the Vertical Auto Profile (VAP) test or the Lipoprotein Particle Profile (LPP) test. Learn more about these two cholesterol tests. (Both tests are covered by Medicare and most insurance plans.) Then get my recommendations for what numbers indicate optimal cholesterol levels.

WATCH: Why You Should Ask Your Doctor for a Cholesterol Fractionation or Particle Size Test

More Dr. Sinatra Advice on Achieving Healthy Cholesterol Levels

Want to achieve optimal cholesterol levels with your diet? Learn about the dietary changes that are necessary for healthy cholesterol levels.

Want to achieve optimal cholesterol levels with nutritional supplements? Discover which nutrients you need to add to your supplementation program to promote healthy cholesterol levels.

Want to achieve optimal cholesterol levels with exercise? Find out about the positive impact regular exercise can have on your cholesterol levels.