At first glance it would seem that patients with smaller LDL particles are at greater risk for atherosclerosis than patients with large LDL particles, all things equal.* Hence, this idea that Pattern A is “good” and Pattern “B” is bad has become quite popular.
To address this question, however, one must look at changes in cardiovascular events or direct markers of atherosclerosis (e.g., IMT) while holding LDL-P constant and then again holding LDL size constant.* Only when you do this can you see that the relationship between size and event vanishes.* The only thing that matters is the number of LDL particles – large, small, or mixed.
“A particle is a particle is a particle.”* If you don’t know the number, you don’t know the risk.