Nick NorwitzMD PhD, Oxford-Harvard | Metabolic Health Educator | “Stay Curious”

LDL 400 and No Heart Disease

28 Oct 2025 · 1 min

Watch on YouTube

0:57

In this brief monologue, a clinician‑researcher describes his 60‑year‑old mother, also an MD‑PhD, who has an exceptionally high LDL cholesterol level of approximately 400 mg/dL yet shows no arterial plaque on CT angiography. He uses this striking case to argue that while elevated LDL and ApoB are recognized risk factors, they are not sufficient on their own to cause atherosclerotic cardiovascular disease. He stresses that biomarkers must be interpreted within the broader context of an individual’s metabolic health, personal and family history, and the potential risks of treatment, advocating for a patient‑centered approach rather than treating isolated lab values.

Chapters

My mother, who's an MD-PhD like me, has an LDL cholesterol level around 400 mg/dL. That is astronomical. She just turned 60, and guess what? She has zero arterial plaque as confirmed by CT angiography. That's not a flex. It's a fact. It's a provocative fact, yes, but still a fact, and I share it to highlight one of the most controversial, yet least controversial, truths in cardiology. High LDL cholesterol and ApoB are not sufficient to cause cardiovascular disease or atherosclerosis. That doesn't mean they aren't risk factors, that doesn't mean they don't matter, but like all biomarkers, they must be interpreted in context. Context that includes a person's metabolic health, family and personal history, and potential risks of particular treatments. Bottom line: treat the individual, not the isolated marker. That shouldn't be controversial.