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To the Editor: Dr Campos and colleagues reported that larger low-density lipoprotein (LDL) particle size is associated with increased risk for recurrent clinical events in patients with coronary heart disease (CHD).¹ Their conclusion that larger, cholesterol-enriched LDL can be more atherogenic is consistent with evidence from animal models² as well as with an earlier case-control study of normolipidemic patients with angiographically defined CHD.³ However, their data do not exclude an atherogenic role for small, dense LDL, which has been strongly related to the risk for developing CHD in several other large cohorts⁴ and for which multiple proatherogenic features have been demonstrated in vitro. For example, compared with midsized LDL, subspecies at both extremes of the LDL size and density distribution have been shown to have reduced LDL receptor affinity.⁵

It appears that in the sample of Campos et al, the strength of the relationship of large LDL subspecies to CHD . . . [Full Text of this Article]

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