Of course, the million dollar question is how you do all of this? (Actually, it’s probably a 10 billion dollar question as hospitals would be empty if we got heart disease under control.) The key to managing heart disease is to manage arterial plaque (atherosclerosis). No plaque – no (or very little) heart disease. It’s that simple. And to do that you actually have to monitor a wide variety of lipid and inflammatory markers.
The most common metrics are HDL, LDL and triglycerides and I give a lot of coverage to these on my site because of it. These are very affordable and are part of almost every man’s annual physical exam, so it just makes sense to be well-versed in this “Lipid Trifecta.”. The men who have shown us the way in my opinion with these markers are three physicians and researchers that I call The Plaque Regressers: Dr. Gould, Dr. Esselstyn and Dr. Davis. All three of them have strict guidelines on LDL and two of them on LDL, HDL and triglycerides. You can see the kind of numbers that they talk about in my page on LDL Levels and HDL, LDL and Triglycerides.
However, on this page, I want to discuss a less well-known, but every more powerful marker to monitor your lipids and make sure that you regress or maintain the calcification in your arteries: LDL-P (the LDL Particle Count). As important as LDL, HDL and triglycerides are, the big gun according to the latest research is LDL-P and I’ll discuss just why below.
1. Low LDL-C Can Backfire. All the Plaque Regressers want you to have low LDL (< 80). There are a hundred gurus out there who will tell you that LDL-C does not matter, but they are risking their arterial health in my opinion. Their assumptions are based largely on studies comparing atherosclerosis in the general population. But we don’t want to be just be a little better than the general public, who on average have very diseased cardiovascular systems. We want NO plaque.
And, according to the Framington Offspring Study data, about 9% of all individuals will have low LDL-C and high LDL-P.  Those who fall into this category actually have high heart disease risk. The clear message of this study was that low LDL-C is NOT a guarantee against heart disease – quite the opposite. To truly proect yourself, you have to have low LDL-C and low LDL-P.
Another way to look at this is that, according to that same data, 18.4% of those with no known heart disease will have low LDL-C also have high LDL-P. So, if you have low LDL-C, you cannot just assume you are out of the woods and, to play it safe, you should also pull LDL-P.
Low Fat Diets: Does this mean that the low fat diet gurus were all wrong? No, of course not. First of all, 82% of those with low LDL-C also have low LDL-P, so, generally speaking, going for low LDL is a great starting point. Furthermore, the low fat gurus almost all emphasize a lifestyle that will try to keep a man out of prediabetes and prediabetes is what usually causes high LDL-P is individuals with low LDL-C. However, a poorly implemented low fat diet based on wheat and higher glycemic carbs in a man that is overweight and/or sedentary could cause problems without a doubt. Again, pulling that LDL-P number to play it safe is the way to go.
By the way, I really admire the original low fat guru Nathan Pritikin for his stance on this issue in the pre-LDL-P days. He not only consumed a low fat diet but jogged an hour every day. And it worked for him fantastically as he died, per a coroner’s report, with perfectly clear arteries (and very likely had significant arterial plaque early in life). The coroner examined him after his death and declared that “Nathan Pritikin’s arteries were free of any signs of heart disease, and were as “soft and pliable” as a teenager’s. “In a man 69 years old,” wrote pathologist Jeffrey Hubbard, “the near absence of atherosclerosis and the complete absence of its effects are remarkable.””  No, it’s never too late to clear out arterial plaque.
According to the Framington Data, he is both high LDL-C and LDL-P, placing him in the worst category. Of course, I hope that he is an exception somehow, but my point is that this is the big question with regard to Low Carb and some Paleo Diets that are higher fat. (NOTE: There is a study out there that says if you lose weight on Low Carb, you can regress plaque. But what happens when you stop losing weight and you are in “maintenance mode?”)
NOTE: I believe a Low Fat Paleo Diet is the safest way to go and the best implementation of true Paleo, since wild game is almost always low fat.
2. LDL-P Best Predicts Heart Attack Risk. The above study found that the LDL Particle Count was the single best predictor or future cardiovascular disease risk. The study basically looked at individuals without known heart disease and then followed them until their first cardiac event and, again, LDL-P was the superstar.
NOTE: I cover this in even greater detail and more studies in this page: LDL-P, the Best Predictor of Heart Disease.
3. LDL-P Is Very Correlated to Arterial Plaque Levels (IMT). Many of you know that I push getting a Heart Scan or IMT score to track your plaque levels. Of course, this isn’t my idea: all the Plaque Regressers do it. One of the ways you can monitor your plaque is through an IMT, which is a non-invasive ultrasound of your carotid (neck) artery. One study found that IMT scores were correlated with LDL-P, i.e. the higher the Particle Count, the thicker the neck artery with plaque. 
CONCLUSION: Having Low LDL-P gives a good probability that you will have a much lower risk of heart disease. To improve these odds still further, you should also strive to have low LDL-C as well as low LDL-P. Generally speaking, men without prediabetes, which usually means a decent triglcyerides-to-HDL ratio, and low LDL-C will be in good shape and have a low LDL Particle Count. But it is better to pull this number to make sure. If you want to feel young and stay young, you have to keep those arteries plaque free. This will also maximize your nitric oxide levels and improve your sex life as well.
What should you target for LDL-P? I make a case for values between 700 and 850 nmol/l in this page on LDL-P Particle Count Target Levels for Plaque Reversal. Read this page and you will see some of the research data on this subject.
1) J Clin Lipidol. 2007 Dec 1; 1(6): 583 592, “LDL Particle Number and Risk of Future Cardiovascular Disease in the Framingham Offspring Study Implications for LDL Management”
4) N Engl J Med, 1985, 313:52, “Nathan Pritikin’s Heart”, https://www.pritikin.com/eperspective/specialissues/pritikinatkins/
5) May 2007Volume 192, Atherosclerosis, May 2007, 192(1):211 217, “LDL particle subclasses, LDL particle size, and carotid atherosclerosis in the Multi-Ethnic Study of Atherosclerosis (MESA)”