Individuals with familial hypercholesterolemia and lifelong LDL levels of 400-600 mg/dL can have zero atherosclerosis, suggesting LDL is not the sole cause.

“FH is arguably the most heterogeneous collection of genes you can imagine so why would we exclude looking at those people when that's in many ways one of the richest bodies of evidence for a natural experiment in to answer the question can you have high LDL C high HDL C low triglyceride and still get atherosclerosis”