Why is high LDL bad? Is there a chance this was not truly the case?


High levels of low-density lipoprotein (LDL) cholesterol are often considered a risk factor for cardiovascular diseases, such as heart disease and stroke, primarily by contributing to the buildup of plaque in arteries, leading to atherosclerosis. However, the relationship between dietary cholesterol, saturated fat, and serum cholesterol levels has been subject to debate and nuanced discussion.

has discussed the complexity of the issue and the distinction between dietary cholesterol and fat, highlighting that not all instances of increased saturated fat intake may directly influence LDL levels. He also points out the importance of a cholesterol component called apolipoprotein B (apoB) as the primary driver of atherosclerosis, not just the quantity of LDL cholesterol itself. To prevent cardiovascular disease, he emphasizes keeping apoB levels low and asserts that cardiovascular disease begins to develop from a young age 1.

touched on the effectiveness of statins, which are drugs used to lower LDL cholesterol, in reducing heart disease risk. While acknowledging some benefit for certain patients, he also notes that for primary prevention, where someone has not had a previous heart event and is prescribed statins simply for high LDL levels, the average increase in lifespan is minimal (around four days), with an increased risk for diabetes 2.

and explored the confusing nature of cholesterol literature. They discussed the potential disconnect between dietary cholesterol intake and serum cholesterol levels, and the fact that there seem to be cases (such as anorexics with very high LDL despite low dietary cholesterol intake) that further complicate our understanding of the relationship between diet, cholesterol, and health 3.

Atherosclerosis Prevention

Peter Attia explains that APOB is the causative agent of atherosclerosis, and keeping its levels below 30 milligrams per deciliter is necessary to prevent heart disease. He also emphasizes that APOB levels need to be maintained since cardiovascular disease starts developing from birth.

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In essence, although high LDL is widely seen as negative for cardiovascular health due to its association with atherosclerosis, the interplay with dietary cholesterol and saturated fat is complex, and individual responses to dietary components may vary. Discussions within the indicate there are varying perspectives on the subject, and the scientific community continues to investigate the nuances of this relationship.