Cholesterol Particle Test

Q:  I went to a talk about heart disease and cholesterol, and the speaker mentioned the importance of measuring the cholesterol "particles" and not just cholesterol. My doctor said my cholesterol was fine. Does that mean the particles are "fine," too?

A:  The standard cholesterol test in your doctor's office measures total cholesterol, LDL ("bad") cholesterol, HDL ("good") cholesterol and triglycerides. The cholesterol particle test, which measures the size of the LDL particles, is a test not ordered routinely.

"Pattern A" particles are larger and lighter, while "Pattern B" particles are smaller and more dense. People with Pattern B LDL cholesterol are more likely to suffer from atherosclerosis and heart disease.

Dr. Jim Kleczka, Medical Director of Cardiology Inpatient Services at the Medical College of Wisconsin, tells me that he usually requests the LDL particle test when he has a patient with heart disease and a normal cholesterol level.

"If the LDL cholesterol is where we want it, but the LDL particles are small, I generally prescribe a cholesterol-lowering medication, while I might not if both the LDL and the particle profile are normal."

At the same time, Kleczka doesn't think everyone needs their LDL particle size checked. For instance, if a patient is already on a cholesterol-lowering medication, knowing the results of an LDL particle test will not change the doctor's plan of care, since there isn't a medicine specifically made to change the LDL particle profile.

Julie L. Mitchell, MD, MS, is an Assistant Professor of Medicine at the Medical College of Wisconsin. She practices internal medicine at the Froedtert & Medical College General Internal Medicine Clinic - East. Her column appears in the Milwaukee Journal-Sentinel.