So - I agree it does sound like I have, what I thought was VLDL does seem as if it's pattern B, ias long as that's the one that does the damage?
So .... does the calculated LDL value given in the tests (cos they don't test for it specifically, do they? - just work it out from the things they do test for) exclude the Pattern B then? I understood it was the total calculated LDL which would include the large fluffy molecules (ie the good guys) as well as the smaller ones that do the damage? (whether they are called VLDL or Pattern B) (so does that make VLDL Pattern A????)
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The pores in the outer layer of the artery walls are an average of 26nm wide.
The average width of LDL is 22nm ie. most LDL can get through the 26nm pores in the artery walls and enter the endothelium ( the space between the outer and inner walls of the artery). In the endothelium the LDL spills its cargo of cholesterol ( each LDL particle is carrying on average 1500 molecules of cholesterol) onto inflamed macrophages,. The cholesterol thus deposited builds up into foam cells ( which start in childhood), "Fatty Streaks", atheromas, plaques, narrowing of the arteries, cvd etc
There are hypothesised as being three distributions of LDL ..
Pattern I ... a normal pattern with a bell shape curve of LDL centred on the average width of 22nm. This "normal" pattern of LDL is atheromatic because they are clustering well below the average arterial pore width of 26nm i.e. LDL is hazardous even at a normal distribution.
Pattern A ... this is where the average width of LDL is above the 26nm pores width. It is less atheromatic because less LDL can get through the pores into the endothelium but there is still a tail of LDL that can get through.
Pattern B... this a distribution of LDL which has the average width below the average of LDL itself i.e. this distribution ( Pattern B) is highly atheromatic since most can get through and deposit cholesterol in the endothelium.
What's extremely annoying is that diabetics are prone to Pattern B ( the really damaging distribution).
Some people on the support groups seem to have got the idea that there are two types of LDL ( large and fluffy versus small and dense). This is not really true, LDL is much the same whatever average width it has. The terms, Pattern A and Pattern B don't really refer to different kinds of LDL but rather to the pattern of distribution around the average width of 22nm.
Pattern A ( the relatively benign) distribution is quite rare and has really only been seen in hereditary circumstances.
Of course it is virtually impossible to discover what pattern of LDL you have without extensive, expensive tests. So basically the average diabetic Joe just needs to follow standard advice and get the LDL under 2 ( usually via Statins).Trying to determine what pattern of LDL you have from the TRigs figure appears to be largely clutching at straws.
VLDL is large as the name,"very low density", implies and has nothing to do with LDL and cannot get through the 26nm pores in the artery walls. VLDL degenerates after it gives up its content (cholesterol and APoE) into VLDL-fragments, which can be atheromatic, and are metaphorically described as "LDL".
