Which lipoprotein is the second most atherogenic?

• A. LDL
• B. VLDL
• C. HDL
• D. Chylomicrons

Answer: (B)

Lipoprotein-related risk for atherosclerosis varies by particle type. LDL is the primary driver of plaque formation because it readily penetrates the arterial wall, becomes oxidized, and is taken up by macrophages to form foam cells. VLDL contributes as well; it carries triglycerides and is metabolized into IDL and then LDL, with its remnants capable of depositing in the vessel wall and promoting atherogenesis, though its overall impact is generally less than that of LDL. HDL, in contrast, supports removal of cholesterol from plaques and is protective. Chylomicrons are large, triglyceride-rich particles cleared quickly after a meal and do not significantly promote atherosclerosis. So the second most atherogenic lipoprotein is VLDL.