What is a B pattern of Low-Density Lipoprotein (LDL)?

From the Guidelines

Pattern B LDL refers to a specific type of LDL cholesterol particle that is smaller and denser than normal LDL particles, often associated with hypertriglyceridemia, low HDL-C, abdominal obesity, insulin resistance, and other metabolic irregularities. This pattern is considered more atherogenic due to its susceptibility to lipid peroxidation and its ability to easily penetrate arterial walls, contributing to plaque formation 1. The characteristics of pattern B LDL include elevated levels of apo B, which is found in LDL and VLDL, and a lipid composition that contains less cholesterol and phospholipid but more triglyceride 1.

Key Features of Pattern B LDL

• Smaller and denser LDL particles
• Often associated with metabolic syndrome, insulin resistance, diabetes, and obesity
• Elevated levels of apo B
• Lipid composition with less cholesterol and phospholipid but more triglyceride
• More susceptible to lipid peroxidation and atherogenesis

Clinical Implications

Pattern B LDL is particularly concerning because these smaller particles can more easily penetrate arterial walls and contribute to plaque formation, increasing the risk of cardiovascular disease 1. To address pattern B LDL, lifestyle modifications are typically recommended first, including a diet low in refined carbohydrates and sugars, regular exercise, weight management, and avoiding smoking. Medications like statins, fibrates, or niacin may be prescribed if lifestyle changes aren't sufficient 1. Regular monitoring of lipid profiles is important, as standard cholesterol tests don't typically differentiate between LDL patterns without special testing.

Management and Treatment

• Lifestyle modifications: diet, exercise, weight management, and smoking cessation
• Medications: statins, fibrates, or niacin
• Regular monitoring of lipid profiles
• Special testing to differentiate between LDL patterns may be necessary 1

From the Research

Definition of B Pattern of Low-Density Lipoprotein (LDL)

• The B pattern of Low-Density Lipoprotein (LDL) is a common genetically influenced lipoprotein profile characterized by a predominance of small, dense LDL particles 2.
• This pattern is associated with increased levels of triglyceride-rich lipoproteins, reductions in high-density lipoprotein cholesterol (HDL-C), and increased risk of coronary artery disease compared to individuals with a predominance of larger LDL (pattern A) 2, 3, 4.

Characteristics of B Pattern LDL

• Individuals with the B pattern of LDL tend to have higher levels of triglyceride (TG) and lower levels of high-density lipoprotein cholesterol (HDL-C) 3, 4.
• The B pattern is also associated with a higher percentage of small, dense LDL (sdLDL) particles, which are defined as particles with a diameter of <25.5 nm 3.
• The predominance of sdLDL is closely related to hypertriglyceridemia and low HDL-C levels 3.

Comparison with Other LDL Patterns

• The B pattern of LDL is distinct from the A pattern, which is characterized by larger, less dense LDL particles 2, 5.
• The A pattern is associated with lower levels of triglyceride-rich lipoproteins and higher levels of HDL-C, and is considered to be a less atherogenic profile compared to the B pattern 2, 5.
• An intermediate pattern (A/B) has also been reported, which is characterized by a mixture of small, dense and larger LDL particles 5.