Small dense LDL are more atherogenic when everything is equal. We don't know if they atherogenic per se or in a multifactorial polygenic model of atheroma.
LDL are particles with hydrophilic molecules outside and lipids (TG, cholesterol esters and other esters) inside. They are produced by the liver. Different parameters are genetic.
The shift from small dense LDL toward large buoyant ones depends mostly of the amount of carbs.
The lowering of LDL at large is more depending on the excess of calories and the excess of carbs and sat lipids.
So what could be the good trade off?
There are very few data to compare clinical advantages of lowering LDL at large and shifting LDL profile...
Rationally one can try the two ways
- avoid excess of calories
- reduce carbs
And check the blood profile with measured LDL and apoB100.