LDL - The Final Word
Summary

People whose LDL is high in comparison to their HDL are at a higher risk for cardiovascular diseases. For more details see our review, especially section 4. From the research presented there, one can infer that considering high LDL alone, without considering the HDL level, does not provide a reliable way to assess risk. We note there that the desired total-cholesterol to HDL ratio should be less than 4; having high LDL will increase this ratio to levels that are considered more risky. It is not clear why current clinical guidelines avoid this ratio (other than the probability that considering LDL alone allows the drug manufacturers to sell more statins and other cholesterol-lowering drugs)!

It is now obvious that reducing LDL is to some extent akin to an influenza patient take an aspirin and then deciding that the illness has passed because the fever is lower. These results should not be construed as a reason to avoid statins. Statins do have a role in decreasing the risk of heart disease and they also decrease LDL simultaneously. It seems that the degree of decrease of LDL while on statin therapy is correlated with the degree of protection against heart disease. However, this is true only for statins. There are other reason to hesitate to take statins as we have already noted.

In summary, high LDL is a risk factor for heart disease. However, lowering it does not mean that the risk is mitigated.

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