The Role of Small Dense LDL in the Pathogenesis of Coronary Artery Disease

Raveenan Mingpakanee


Low density lipoproteins (LDLs) are associated with coronary artery disease. LDLs consist of several subclasses, varying in sizes, compositions and densities. Their diameter is 18-25 nm and density range between 1.019-1.063 g/mL. LDL particles are classified into subclasses, comprising mainly large, buoyant LDL and small dense LDL particles. The small dense LDL is a strong risk factor for atherosclerosis. The metabolic origins of small dense LDL are delipidation of very low density lipoproteins (VLDL) and core lipids transfer between VLDL and LDL particles. VLDL serves as a cholesteryl ester acceptor from LDL, becoming a triglyceride-rich particles. Hydrolysis of triglyceride in LDL by hepatic lipase further reduces the size of LDL. The small dense LDL easily penetrates into the arterial wall and undergoes oxidation. Then, oxidized LDL is taken up by macrophage via scavenger receptors, and accumulates in arterial walls. Small dense LDL levels are elevated in atherosclerosis disorders, such as dyslipidemia, insulin resistance, type 2 diabetes and metabolic syndrome. There are various techniques currently available for small dense LDL measurement, but each method requires special equipment which is not generally available in routine laboratories. However, the small dense LDL levels can be estimated from the conventional lipid and lipoprotein parameters to assess risks of coronary artery disease.

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