How to Reduce Your Small, Dense LDL Cholesterol

Having high LDL cholesterol, otherwise known as “bad” cholesterol, is not good for your heart health. However, more studies are now finding that it isn’t only the quantity of LDL circulating in your blood—it’s the quality, too. The type of LDL in your body may influence your risk of having heart disease down the road. Small, dense LDL is a type of LDL cholesterol that is considered to be an emerging risk factor for cardiovascular disease. It is smaller and heavier than typical LDL cholesterol and can increase your risk of developing atherosclerosis. It is thought that small, dense LDL contributes to atherosclerosis because it is small enough to penetrate the walls of arteries, is more susceptible to being oxidized, and stays in the bloodstream longer.

A test tube filled with blood and a cholesterol test
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Risk Factors

Anyone, ranging from young adults to the elderly, can be at risk of developing small, dense LDL particles. It appears that the development of small, dense LDL can be inherited. Additionally, lifestyle can also play an important role in the formation of small, dense LDL.

People at risk of developing small, dense LDL in the blood include:

  • Individuals who consume a high amount of carbohydrates in their diet, especially refined sugars.
  • Those that consume trans fats in their diet.
  • Anyone who has uncontrolled diabetes.
  • Individuals who have been diagnosed with metabolic syndrome.


Small, dense LDL is not routinely measured in a cholesterol test that you would get in your healthcare provider’s office. However, there are tests that can measure small, dense LDL, which include:

These tests can be fairly expensive and are not available at all medical facilities.

Although high levels of small, dense LDL can increase your risk of heart disease, its ability to cause heart disease independently of other factors (such as diabetes and high trans fat intake) has not been fully established.

Routine testing for small, dense LDL is not currently being recommended.

Reducing the Formation of Small, Dense LDL

You can do some things to reduce the formation of small, dense LDL in the blood. Although you cannot do much if you have inherited raised small, dense LDL, you can make some changes to your lifestyle to lower your chances of developing this particle. Ways you can lower your risk of small, dense LDL cholesterol formation include:

  • Lowering your carbohydrate intake—especially refined sugars
  • Lower your intake of saturated fat and omit trans fats from your diet
  • If you have been diagnosed with diabetes, keep it under control by taking medication and following a healthy diet
  • Lose weight if you are obese. This can be accomplished by following a healthy diet and moderate physical activity.
  • If you are already taking medication to lower your cholesterol levels, some of these drugs may also reduce the formation of small, dense LDL. These would include fibrates and statins.
  • Know your risks of having cardiovascular disease in the future. Do you have a parent that had a heart attack at 40? If so, you may be at risk of developing heart disease at a young age, too.
5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Hirayama S, Miida T. Small dense LDL: An emerging risk factor for cardiovascular disease. Clin Chim Acta. 2012;414:215-24.  doi:10.1016/j.cca.2012.09.010

  2. Ivanova EA, Myasoedova VA, Melnichenko AA, Grechko AV, Orekhov AN. Small Dense Low-Density Lipoprotein as Biomarker for Atherosclerotic Diseases. Oxid Med Cell Longev. 2017;2017:1273042.  doi:10.1155/2017/1273042

  3. Malhotra A. Saturated fat is not the major issue. BMJ. 2013;347:f6340.  doi:10.1136/bmj.f6340

  4. Fan J, Liu Y, Yin S, et al. Small dense LDL cholesterol is associated with metabolic syndrome traits independently of obesity and inflammation. Nutr Metab (Lond). 2019;16:7.  doi:10.1186/s12986-019-0334-y

  5. Malhotra A. Saturated fat is not the major issue. BMJ. 2013;347:f6340.  doi:10.1136/bmj.f6340

Additional Reading

By Jennifer Moll, PharmD
Jennifer Moll, MS, PharmD, is a pharmacist actively involved in educating patients about the importance of heart disease prevention.