Reddit reviews Natural History of Coronary Atherosclerosis

The metric is effectively average LDL size. There’s a lot of study of LDL size, specifically using the CardioIQ series of tests which is an ion mobility test which produces a detailed graph of concentration by particle size. The guy who licensed the test to Quest is named Dr. Ron Krauss and has a number of papers published on the topic from that test and one of an earlier generation. I met him at the Weight of the Nation conference in San Francisco last year and he’s quite a cool guy.

One reason these findings aren’t talked about a lot is because most of the findings tend to correlate a high concentration of small-dense LDL particles with higher incidence of CVD. The “problem” is that the small-dense LDL pattern is also associated with low fat, high carbohydrate dietary patterns and seems to get better on a high fat, low carbohydrate diet. In that fashion the finding is actually diametrically opposed to the traditional diet-heart hypothesis which is that fat and SFA in particular => LDL-C => CVD and therefore both cannot be true.

The general topic of CVD and cause w.r.t. lipoproteins is pretty interesting because it exposes the possibility that small dense LDL is strongly correlated with hyperinsulinemia. Krauss contended that he had seen counterexamples in his data but I didn’t get further details at the time.

If you’re interested more in CVD I would recommend Subbotin and Constantin Velican though sadly I appear to have bought the last reasonably priced used copy of his book — he also has a series of papers published in the journal Atherosclerosis from the late 60s through the 80s and performed hundreds of autopsies to develop an understanding of the time series progression of the disease.