Cardiovascular disease kills more than 800,000 people in the United States each year, many of whom could potentially be saved through early treatment with currently available therapies.

Unlike many diseases, cardiovascular disease develops slowly over decades. The process often begins in early adulthood and progresses gradually until it eventually manifests as a heart attack or stroke.

Unfortunately, current diagnostic tools cannot easily detect the earliest microscopic stages of this disease. As a result, treatment is often delayed until substantial damage has already occurred.

The misunderstanding of cholesterol's role in cardiovascular disease — combined with widespread misinformation — has complicated what is, in many ways, a straightforward strategy for reducing risk.

A large body of research demonstrates that cholesterol and the development of atherosclerotic plaque are closely linked. Much of the controversy arises from the complexity of this relationship.

Physicians commonly use LDL cholesterol levels as part of cardiovascular risk assessment. However, LDL cholesterol represents only one piece of a larger puzzle that includes factors such as:

The more pieces of this puzzle that are considered, the clearer the final risk assessment becomes.

LDL cholesterol can sometimes provide a clear indication of risk. In other cases, however, it can produce a misleading picture if interpreted in isolation.

Patients with type 2 diabetes provide a classic example. Many of these individuals have LDL cholesterol levels within the normal range, yet their risk of cardiovascular disease is extremely high.

This apparent contradiction has led some observers to argue that cholesterol levels are not useful indicators of cardiovascular risk. In reality, cholesterol measurements are best understood as surrogate markers that provide insight into a much more complex biological process.

Understanding what a cholesterol test actually measures can help place its value as a predictor of cardiovascular risk into proper context.