Prior to discussing LDL particle numbers as a predictor of risk, a reminder about cholesterol is in order. Cholesterol is absolutely vital to the health of our bodies. It is an important part of cell membranes and and is critical for brain function. The sex hormones estradiol, progesterone and testosterone cannot be produced without it. Cholesterol is also the precursor to the stress hormones norepinephrine and cortisol as well as vitamin D. Inadequate cholesterol effects mood as it is crucial in maintaining neurotransmitter balance.  These are some of the reasons that vilification of cholesterol as a cause of heart disease and indiscriminate lowering of cholesterol has never been wise. I am glad that the understanding of cholesterol transport has increased and the focus has shifted from cholesterol to the fat/protein transport particles which carry it in the blood. Unfortunately, a single minded focus on LDL particles still widely misses the mark, but it’s an improvement. Low density lipoproteins carry cholesterol from the liver to the rest of the body for utilization. It is these particles which can enter into the lining of blood vessels and trigger an immune response which ultimately leads to plaque formation. LDL particles become dangerous when they are oxidized (think rusty) and the vessel wall is inflamed. Size also matters. Smaller, more dense LDL particles are associated with higher triglyceride production and greater risk to arterial walls. The true villain is lifestyle factors such as eating high carb/high processed fat foods (think high fructose corn syrup and flour blended with trans fats, omega 6 fats, rancid fats and some mysterious chemicals). Throw in smoking, not exercising, not sleeping enough and chronic stress and you have a perfect storm of large numbers of small dense LDL particles which readily enter inflamed, vulnerable vessel walls and become oxidized. You see, good ole’ cholesterol was never truly the villain and treating it as such has been a massive diversion from the true destroyers of our health.