A doctor challenges the "lower LDL is better" mantra, pointing out that people with LDL around 57 mg/dL still have heart attacks. He argues the real claim is more limited: lower LDL only reduces risk when everything else stays equal, and chasing numbers like 40 or 30 ignores side effects and other organ systems.
Why don't we just lower everyone's LDL to zero? I think lower LDL— it is medical propaganda masquerading as evidence-based medicine. There's a study that came out and there was like people with low quote-unquote optimal LDL still had heart disease, and a lot of people were like, well, it's not low enough, the mean was 57. I'm like, that's your excuse? So what do you want, at 40, 30? We're literally playing cholesterol Uno trying to just like slap it down the cards. And that tagline, that mantra, lower LDL is better, is such nonsense propaganda because what it's really saying is lower LDL and ApoB is better for cardiovascular risk, all else being equal. If we could snap our fingers and lower this one biomarker without thinking about any other organ systems or the side effects of the interventions that lower the LDL.
