The Study
Low-Density Lipoprotein Cholesterol Is Predominantly Associated With Atherosclerotic Cardiovascular Disease Events in Patients With Evidence of Coronary Atherosclerosis: The Western Denmark Heart Registry
This study shows that in middle-aged people with signs of heart artery disease, higher 'bad' cholesterol (LDL) is linked to more heart attacks and strokes over about 5 years. But in people without those signs, LDL doesn’t seem to matter as much — other things like smoking or diabetes are more important.
Analysis score
Maximum 72 for a cohort study.
Where the score came from
This study checks if high 'bad' cholesterol (LDL) leads to heart problems only in people who already have heart plaque.
Where does this study sit?
Reviews of RCTs (Meta-analyses)
Max 100Randomized Trials
Max 90Reviews of Cohort Studies
Max 85Cohort Studies
Max 72Reviews of Case-Control Studies
Max 63Case-Control Studies
Max 58Cross-Sectional & Case Series
Max 50Expert Opinion
Max 559 / 100
Quality score
Groups of people are followed over time to see who develops an outcome. Strong for identifying risk factors and associations, but cannot prove causation as firmly as RCTs.
Key takeaways
Summary
Based on the study abstract and findings.
- 1If you already have heart plaque, lowering LDL matters.
- 2If you don’t, other risks like smoking or diabetes may matter more than LDL.
- 3For every 39 mg/dL more LDL, heart risk went up 14% overall.
- 4But only if plaque was present (CAC > 0).
- 5If no plaque, LDL didn't increase risk.
- 6People with plaque and very high LDL had more than double the risk.
Score breakdown, methodology, conflicts of interest, evidence analysis & raw study data
Publication
Journal
Circulation
Year
2023
Authors
M. Mortensen, O. Dzaye, Hans Erik Bøtker, J. Møller Jensen, M. Maeng, Jacob Fog Bentzen, H. Kanstrup, H. Toft Sørensen, J. Leipsic, R. Blankstein, K. Nasir, M. Blaha, B. Linde Nørgaard
Related Content
Claims (6)
If you're a middle-aged person with symptoms, having higher 'bad' cholesterol (LDL) means you're more likely to have heart problems over the next four years — but only if scans show you already have plaque in your heart arteries.
If you're a middle-aged person with signs of heart disease and calcium in your arteries, having very high 'bad' cholesterol makes your risk of heart problems more than double. But if your arteries are clean, even sky-high cholesterol doesn’t seem to increase your risk.
If a middle-aged person has heart symptoms but no calcium buildup in their arteries, things like diabetes, smoking, and low 'good' cholesterol are linked to future heart problems — but their 'bad' cholesterol level doesn’t seem to matter, which might mean other non-plaque-related issues are causing the heart trouble.
If you have calcium buildup in your heart's arteries, the link between your 'bad' cholesterol and heart problems changes — it’s stronger or weaker depending on that calcium.
If a middle-aged person has higher 'bad' cholesterol, they're more likely to have buildup in their heart arteries — every 38.7-point rise means about a 17% higher chance of early heart disease signs, even if they already have symptoms.
A lot of people with heart problems don't actually have high LDL cholesterol — about half of them have normal or even low levels — so maybe LDL isn't the main cause of heart disease after all.
Not medical advice. For informational purposes only. Always consult a qualified healthcare professional before making health decisions.