The LDL Conspiracy

Opinion 1 — Rethinking Cholesterol: Beyond the Simplistic Narrative

When it comes to health, few topics spark as much fear and confusion as cholesterol. For decades, we’ve been told that cholesterol is the enemy—that it clogs arteries, raises heart attack risk, and should be lowered at all costs. But this narrative is, at best, an oversimplification.

The truth is that cholesterol is not inherently evil. In fact, your body produces it for a reason. Roughly 25% of your brain is cholesterol. It’s a vital molecule for cellular structure, hormone production, and neurological function. Labeling cholesterol as the villain ignores the complexity of human biology.

Metabolic Health Matters More

Mortality isn’t driven by a single number on a blood test. Metabolic health—how well your body manages energy, insulin sensitivity, inflammation, and recovery—likely matters far more than cholesterol alone. A metabolically healthy individual with “high” cholesterol could be at less risk than someone with “normal” cholesterol but poor overall health.

The Flaws of Dietary Studies

Another problem is the way nutritional science often works. Correlation gets mistaken for causation, and self-reported dietary studies are notoriously unreliable. Up to 99% of people misreport what they actually eat. From that shaky foundation, sweeping statements like “saturated fat is bad” are born, and then repeated until they feel like truth.

But look closer: these claims don’t hold up against either evolutionary history or common sense. Our ancestors didn’t have access to vegetable oils or processed food. In harsh winters, vegetarian or vegan diets were not an option. They survived—and thrived—on what was available, which included animal fats.

The Illusion of Longer Life

Yes, life expectancy has increased, but much of that improvement comes from reduced childhood mortality, not because adults are living dramatically longer, healthier lives. Many people today live into old age, but in misery—frail, sick, and dependent. Extending lifespan without improving healthspan is hardly a victory.

Closing Thought

Health cannot be reduced to a single lab marker or a simplistic slogan. Cholesterol is not a poison; it’s a building block of life. Instead of obsessing over numbers, we should focus on overall metabolic health, strength, and vitality. The real challenge isn’t lowering cholesterol at any cost—it’s finding ways to live well and age with resilience.

Opinion 2 — A Cardiologist’s View: LDL Is Causal and Modifiable

From a clinical and research perspective, low-density lipoprotein (LDL) cholesterol is a causal driver of atherosclerosis. Multiple lines of evidence—genetics (including Mendelian randomization), imaging, and large randomized controlled trials—converge on the same point: higher cumulative exposure to LDL increases cardiovascular risk, and lowering LDL reduces it.

Risk reduction appears proportional to the degree and duration of LDL lowering. Diverse therapies that act through different mechanisms (for example, statins, ezetimibe, and PCSK9 inhibitors) consistently demonstrate event reduction alongside LDL decreases, suggesting the benefit relates to the LDL change rather than any single drug class.

Diet and lifestyle matter, too. Replacing saturated fats with unsaturated fats, maintaining a healthy body composition, improving cardiorespiratory fitness, and avoiding tobacco all contribute to lower risk. Dietary patterns such as Mediterranean-style eating are associated with fewer cardiovascular events, likely through combined effects on lipids, inflammation, and metabolic health.

Cholesterol is essential for life, but context matters. LDL is one modifiable piece of a larger risk profile that includes age, blood pressure, diabetes, kidney function, and inflammatory conditions. Metabolic health is important, yet for people at elevated risk, ignoring a high LDL can leave preventable risk on the table.

Note: These perspectives are personal opinions intended for discussion and education—they are not medical advice. Individuals should discuss lab results, goals, and treatment options with a qualified clinician.