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.
if LDL is directly toxic to the endothelium why don't we get plaques in veins because there's the same amount of LDL in all of our circulation there's a same amount of LDL circulating in an artery as there is in a vein and so if LDL itself is enough to initiate a plaque... well why don't I get out through a sclerotic plaque or why don't I get plaque in a vein
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if LDL is enough to initiate atherosclerosis why don't we get atherosclerosis and veins atherosclerosis only occurs in arteries which are high pressure and probably because of the high pressure damages the endothelium
arteries develop atherosclerosis because they're subject to high pressure when we often see atherosclerosis if branch points where there's turbulence and that turbulence can sometimes damage the artery wall
we do not get atherosclerosis in veins which are lower pressure vascular tree in the human body but if we transplant that vein into the arterial circulation like we do with a cabbage a coronary artery bypass graft it gets atherosclerosis very fast faster than an artery
if ldl is directly causing injurious injury to the endothelium why do you only accumulate atherosclerosis in the arteries and not the veins they all have endothelium the concentration of ldl is the same in all of them
if ldl is directly causing injurious injury to the endothelium why do you only accumulate atherosclerosis in the arteries and not the veins they all have endothelium the concentration of ldl is the same in all of them there's something else going on
why do we get atherosclerosis only in arteries and not in veins when the veins are within a physiologic system of low pressure if ldl were injurious to the endothelium which is the same in veins and arteries why does it not cause atherosclerosis in veins it will cause atherosclerosis in a vein if you put that vein into an arterial circulation but what we know is that the higher pressure of our arteries millimeters of mercury during systole which is when the heart contracts 80 millimeters of mercury during diastole versus much lower pressures in the veins does damage the endothelium
we don't get atherosclerosis in our veins because the veins are a low pressure system atherosclerosis only happens in high pressure systems
in veins veins are so much lower pressure they do not have the damage from the higher pressure in the arterial system which denudes which scrapes off the endothelium in those arteries
We only get atherosclerosis in our arteries, really no matter what our systemic blood pressure is. Now, these blood vessels are contiguous. The same amount of LDL particles, the same amount of apoB-containing particles are circulating through the veins and the arteries. And the endothelium looks exactly the same on the inside. Why do we only get atherosclerosis in the arteries? Because the arteries are a higher-pressure system. And that high pressure damages the arteries. And that damage to the arteries is where the beginnings of atherosclerosis lie.
the difference is that arteries and this probably plays into the arteries versus veins arteries can actually hang on or retain um lipoproteins and that was the actual difference