A study found 37% of people with LDL of 57 mg/dL still had atherosclerosis. The speaker argues medicine overemphasizes LDL relative to its actual impact on heart disease, missing broader factors that matter more for cardiovascular health.
Can you have super low LDL cholesterol and still get heart disease? Well, a study published in Atherosclerosis found that 37% of people with optimal, very low LDL cholesterol, a mean of 57, still had atherosclerosis, 37%, as measured by coronary artery calcium scan or carotid ultrasound. Now, as a group, they did slightly better than the general population, but the difference was small. So the takeaway here isn't that LDL ApoB don't matter at all. It's really that they take up a disproportionate amount of the conversation for how much they actually do matter. The real point is that the spotlight of medicine isn't guided by what improves patient health the most, it's shaped by incentives and economics. And when we adopt a keyhole focus on a single biomarker, we miss the bigger picture, and that can actively harm health. So, am I saying that an overemphasis on LDL is one of the main reasons cardiovascular disease morbidity and mortality remains so high? In my opinion, yeah. And that's exactly what I'm saying.
