Paul Saladino· MD
we talked about the positive functions of LDL the fact that it has a real role we talked about the idea that there's really not solid data that a LDL is directly toxic to the endothelium or initiates plaque formation
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The headline is broadly defensible, but the qualifications matter. Effect sizes vary by population, the strongest claims rest on shorter trials, and credible voices push back on how it's typically framed.
we talked about the positive functions of LDL the fact that it has a real role we talked about the idea that there's really not solid data that a LDL is directly toxic to the endothelium or initiates plaque formation
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that assumes or that is predicated on the fact that LDL is a bad molecule or that LDL cholesterol is actually going to be an issue when it's higher and I would say that that discussion hinges on the question of whether LDL is directly toxic to the endothelium or not within mainstream lipid ology that would be you know people like Tom Dayspring Peter attea these are these are people who are you know well steeped in the lipid literature and would espouse the mainstream perspective they would say that the best theory is called response to retention
and the response to retention model posits that when you have more LDL there will be a higher propensity just because of a numbers game for the LDL to get retained in the sub endothelial space and that would suggest that LDL is directly toxic to the athelia more that LDL is somehow triggering its own retention
but the foundational question is do we believe that low density of a protein a spherical molecule that carries triglycerides and cholesterol is inherently atherogenic or damaging to the endothelium the inside of an artery
So, it's not a video picture. Nobody knows exactly where those LDL particles are going to. You know, if you're making more LDL particles because you're delivering their payload to your muscles and none of them are taking kind of a side detour into your artery wall, that's like a no harm, no foul type situation.