The evidence is convergent. Multiple independent sources reach the same conclusion, the underlying mechanism is well-characterized, and even the field's most cautious voices treat it as worth doing.
in order to make the case for a single lipid data to be causal you need to likewise state plainly that you're certain that things like atherogenic dyslipidemia do not affect lipid levels like ldl since that is the the point of interest in other words in order to say a causes b you need to be sure of two things that are not the case which is that b has any effect over a and and this is important that there's no c or d or e or anything that's causing both
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in order to say we can make the case that ldl is causal with single lipid data you you have to be able to confirm that that's the case also with combination lipid data you can't make the case only in single lipid data
ldl does not cause atherosclerosis de novo i'm not saying that ldl is not involved in the atherosclerotic plaque and in fact a subset of ldl called lp little a probably is very involved in the atherosclerotic plaque is it possible that in the setting of metabolic dysfunction if you have more ldl around that could look worse yeah but also is it possible that having a lot of ldl around without metabolic dysfunction to spark the fire could be helpful or not benefit not harmful at all because ldl itself doesn't initiate atherosclerosis
you can't have I mean fire without wood but wood doesn't cause a fire you need a spark an LDL doesn't look like it's enough to incite atherosclerosis
if you're saying is it part of the development of an a thorough sporadic plaque it's nearly a hundred percent if you're saying is it the total quantity of LDL particles absent any inflammation or anything else nobody's saying that nobody reasonable is saying that
so you've got three things that we can sort of use a metaphor and say they form the three legs of the stool three things have to happen for someone to get atherosclerosis each of them is necessary none of them alone are sufficient