Beyond LDL: Reevaluating the Pathogenesis of Atherosclerosis

Background:Atherosclerosis is a major contributor to cardiovascular disease, traditionally linked to elevated levels of low-density lipoprotein (LDL) cholesterol. However, recent findings raise critical questions regarding the causal relationship between LDL and the pathogenesis of atherosclerosis.Material and methods:This study re-analysed data from approximately 14,000 patients, focusing on the relationship between LDL lowering and related deaths. We employed new statistical methods to assess the relationship between LDL levels and outcomes.Results:Our findings revealed a lack of a definitive causal link between LDL levels and the incidence of atherosclerosis. While a reduction in LDL cholesterol was achieved in the patient cohort, this did not caused a significant decrease in all-cause mortality, suggesting that other factors than LDL may play a more critical role in the development of atherosclerosis.Conclusion:The results of this study cast doubt on the established paradigm of LDL as the primary driver of atherosclerosis. This reevaluation invites further investigation into alternative mechanisms underlying atherosclerosis and highlights the necessity for a more nuanced approach to cardiovascular risk assessment and management.