LDL particles are modified by metabolic dysfunction, inflammatory signaling, and oxidative stress, which can trigger immune responses leading to plaque formation.

“what happens is when we start to get into into the weeds with these studies and you really can get into the weeds with these studies what you see is because LDL is involved in plaque formation there's going to be associations but it doesn't necessarily mean that LDL by itself is just the driving factor for plaque formation and cardiovascular disease there's a variety of other factors that are occurring that are leading to changes and modifications in the LDL which we can talk about and that's usually driven by metabolic dysfunction and by inflammatory signaling and oxidative stress that modify LDL particles trigger immune response and then you start to get plaque formation”