Familial hypercholesterolemia, where genetic predisposition to high LDL leads to heart disease regardless of metabolic health, counters the argument that LDL is not causal for heart disease in metabolically healthy individuals.

“based on your knowledge and experience with FH which spans the spectrum of metabolically healthy to unhealthy people How likely do you think that is these patients that you mentioned before are always used as the stick to beat people like me because they say if LDL is truly causal it's impossible that some people don't get heart disease while having FH”