"The same patterns are observed: 1) LDL-P is the best predictor of adverse cardiac events. 2) LDL-C is only a good predictor of adverse cardiac events when it is concordant with LDL-P; otherwise it is a poor predictor of risk. Amazingly the persons with the worst survival had low (below median) LDL-C but high LDL-P. The patients most likely to have high LDL-P with unremarkable or low LDL-C are those with either small LDL particles, or TG-rich / cholesterol poor LDL particles, or both (e.g., insulin resistant patients, metabolic syndrome patients, T2DM patients). This explains why small LDL particles, while no more atherogenic on a per particle basis than large particles, are a marker for something sinister."
"If you want to stop atherosclerosis, you must lower the LDL particle number."
"If you were only 'allowed' to know one metric to understand your risk of heart disease it would be the number of apoB particles (90-95% of which are LDLs) in your plasma ... If this number is high, you are at risk of atherosclerosis. Everything else is secondary."
"There's an increasing consensus that measuring particle concentrations of LDL—the whole particle, not just its cholesterol content—is a more meaningful and, in many cases, a more accurate means for assessing risk. And even more importantly, for defining goals of treatment. This whole area of particle testing has been categorized as 'emerging' technology, even though it's been emerging for three decades now."