LDL cholesterol is one of the most important factors involved in the development of atherosclerosis.
In general, higher LDL cholesterol over time increases cardiovascular risk. But a cholesterol result cannot directly show whether atherosclerosis is already present in the arteries of the heart.
A 2024 analysis from the Miami Heart Study examined 1 808 adults aged 40–65 who had no cardiovascular symptoms and were not taking statins. Researchers used CT imaging to look directly for plaque in the coronary arteries.
The results showed considerable differences between individuals.
Among participants with LDL cholesterol below 70 mg/dL, 33% had coronary plaque. Non-calcified plaque was present in 22.4%.
At the other end of the spectrum, some people with very high LDL cholesterol had no detectable plaque. Among participants with LDL cholesterol of 190 mg/dL or higher, 40% had no coronary plaque.
These findings do not reduce the importance of LDL cholesterol. Instead, they show that LDL cholesterol and existing coronary atherosclerosis provide different information.
LDL cholesterol is an important factor in the development of atherosclerosis over time. But a single LDL measurement cannot tell us how much plaque is already present in an individual person’s coronary arteries.
This is why cardiovascular risk should not be interpreted from one laboratory result alone. Age, blood pressure, smoking, diabetes, family history and other cardiovascular risk factors all contribute to the individual clinical picture.
In selected patients at higher cardiovascular risk, coronary imaging may provide additional information about whether atherosclerosis is already present.
