Variance in the Composition and Number of VLDL and LDL Particles With Increasing Triglyceride or ApoB Concentrations

This study, from Allan Sniderman’s group, dissects a technical but consequential question: as triglycerides or apoB rise, what actually happens to the number and makeup of the lipoprotein particles?

Analyzing nearly 2,000 individuals, the authors showed that VLDL cholesterol rises with triglycerides through both cholesterol enrichment and more particles — but VLDL particle number (VLDL-apoB) only becomes substantial at extreme triglyceride levels. Across the usual range, LDL particles (LDL-apoB) remain the dominant atherogenic species even when triglycerides are high. A key practical implication: VLDL cholesterol is not a reliable stand-in for VLDL particle number.

The work refines the particle-centric view of atherogenic risk. It clarifies that even in patients with elevated triglycerides, the bulk of the apoB particle burden — and thus the risk — usually still resides in LDL, which matters for how clinicians interpret a lipid panel.

We rate the evidence strong for its purpose. It is a careful observational analysis advancing the conceptual precision of apoB-based lipidology, though it concerns particle physiology rather than clinical outcomes directly.