Even in healthy middle-aged Americans with no calcium in their heart arteries, higher 'bad' cholesterol levels are linked to more plaque buildup in the heart's blood vessels.

Middle-aged Americans who feel fine but have high 'bad' cholesterol are more likely to have hidden heart artery plaque, especially if they already show signs of artery calcification — and those with very high cholesterol have the worst kinds of plaque.

Even if a heart scan shows no calcium buildup, nearly 3 in 10 middle-aged people with high 'bad' cholesterol still have soft plaque in their arteries — meaning the usual heart risk test might miss early warning signs.

If a middle-aged person has very high 'bad' cholesterol but feels fine, they’re more than 2.6 times as likely to have early signs of heart artery buildup — even if everything else about their health is accounted for.

Even if someone has high 'bad' cholesterol, it doesn’t seem to reliably predict how much plaque is building up in their heart arteries — some people with very high levels have clean arteries, and their risk of heart events stays low if their scan shows no calcium.

Even if someone has very high 'bad' cholesterol, more than half of middle-aged people with no symptoms still show no signs of heart artery buildup — meaning their bodies might be naturally protecting them.