{
  "release_id": "f6f6f1b6f50379ed",
  "id": "cardio:high-ldl-cholesterol",
  "owner": "cardio",
  "kind": "risk_factor",
  "slug": "high-ldl-cholesterol",
  "name": "High LDL cholesterol",
  "aliases": [
    "High bad cholesterol",
    "Raised LDL"
  ],
  "atlases": [
    "cardio"
  ],
  "summary_plain": "LDL is the type of cholesterol that carries cholesterol through the blood and, when levels are high, builds up as plaque in the artery walls. That buildup can lead to coronary artery disease, heart attack and stroke. Lowering LDL is the aim of the statin, ezetimibe, PCSK9 and bempedoic acid trials in this atlas.",
  "summary_technical": "Defined here as a high level of LDL cholesterol in the blood, as the patient pages from NHLBI and MedlinePlus describe it; neither page gives a number that defines high. The MeSH heading Hypercholesterolemia is wider than the record, so it is a broad match. The trials recorded here set their own LDL entry thresholds, which are stated on their claims.",
  "editorial_state": "draft",
  "last_substantive_edit": "2026-10-14",
  "last_evidence_check": "2026-10-14",
  "next_review_due": null,
  "identifiers": [
    {
      "scheme": "mesh",
      "value": "D006937",
      "normalized_value": "D006937",
      "match": "broad",
      "version": "Not fetched in this repository; resolved by hand in the content plan of 2026-10-13",
      "label": null,
      "from_source": false
    }
  ],
  "navigation": {
    "cardio": {
      "system": [
        "metabolism"
      ],
      "condition-area": [
        "coronary-and-vascular-disease",
        "risk-and-prevention"
      ]
    }
  },
  "payload": {
    "factor_type": "trait",
    "definition": "A high level of LDL (low-density lipoprotein) cholesterol in the blood, the particle that carries cholesterol to the artery walls. No numeric threshold is defined by the sources read.",
    "contexts": [
      "cardio:ctx-nhlbi-medlineplus-adults-coronary-pages"
    ]
  },
  "content_digest": "bfcfb974cf56faf954ab1c356207553a2470244d0053e508698aa823457fad0c",
  "review": {
    "content_digest": "bfcfb974cf56faf954ab1c356207553a2470244d0053e508698aa823457fad0c",
    "current": [],
    "conflicting": [],
    "stale": [],
    "inactive": []
  },
  "claims": [
    {
      "release_id": "f6f6f1b6f50379ed",
      "id": "cardio:claim-high-ldl-raises-cad-risk",
      "owner": "cardio",
      "subject_entity_id": "cardio:high-ldl-cholesterol",
      "category": "descriptive",
      "statement": "MedlinePlus says that a high LDL level means too much LDL cholesterol in the blood, that this extra LDL forms plaque in the arteries, and that coronary artery disease is that plaque buildup in the arteries of the heart. NHLBI adds that plaque built up from high LDL cholesterol raises the risk of heart attack, stroke and other conditions.",
      "context": {
        "id": "cardio:ctx-nhlbi-medlineplus-adults-coronary-pages",
        "label": "Adults, general patient-education statements on NHLBI and MedlinePlus pages about coronary disease, heart attack and cholesterol",
        "recipient": "adult",
        "population": "Adults in general. The pages are written for the public and give no study population, age range or risk group for these statements.",
        "care_setting": "General health information for the public; no care setting is stated",
        "geography": "United States (pages of US government agencies; some figures on them are US statistics)",
        "life_stage_note": "Adults. The NHLBI coronary page gives a prevalence for adults aged 20 and older.",
        "life_stage_terms": null,
        "gestational_age_min_days": null,
        "gestational_age_max_days": null,
        "gestational_age_basis": null,
        "postnatal_age_min_days": null,
        "postnatal_age_max_days": null,
        "gestational_age_status": null,
        "postnatal_age_status": null,
        "followup_description": "Not applicable (descriptive statement)",
        "eligibility": {
          "inclusion": [],
          "exclusion": []
        }
      },
      "evidence_stage": "unknown",
      "certainty": "not_assessed",
      "certainty_method": null,
      "limitations": "Patient-education pages. They explain how the process works and give no study, no size of risk and no LDL threshold. They say high LDL raises the risk of coronary artery disease, not by how much.",
      "editorial_state": "draft",
      "checked_at": "2026-10-14",
      "next_review_due": null,
      "valid_from": null,
      "valid_to": null,
      "citations": [
        {
          "evidence_role": "supports",
          "locator": "Summary, How can a high LDL level raise my risk: \"This extra LDL, along with other substances, forms plaque.\"",
          "applicability_note": "MedlinePlus explanation of how high LDL leads to plaque.",
          "snapshot": {
            "id": "cardio:medlineplus-ldlthebadcholesterol-2026-10-14",
            "retrieved_at": "2026-10-14T18:21:46Z",
            "content_hash": "4967a402c8b5c32e8f1757f843be17908505c3b749c98b7001fd7aa8f533d1a6",
            "source_effective_date": null,
            "public_archive_url": null,
            "source_state": "current"
          },
          "source": {
            "id": "cardio:medlineplus-ldlthebadcholesterol",
            "source_type": "webpage",
            "title": "LDL: The Bad Cholesterol (MedlinePlus health topic)",
            "canonical_url": "https://medlineplus.gov/ldlthebadcholesterol.html",
            "identifiers": [],
            "publication_date": null,
            "publisher": "U.S. National Library of Medicine (MedlinePlus)",
            "edition": "Page fetched 2026-10-14.",
            "reuse_basis": "MedlinePlus states that works produced by the federal government are not copyrighted, and lists the summaries on health topic pages and Genetics pages as public domain (the page titled Linking to and Using Content from MedlinePlus, fetched as cg-medlineplus-usingcontent.html, sha256 31267ce9db016893b80c5665312d92ffc8c34ec86916f84708c353936ba52228). It names the A.D.A.M. encyclopedia, drug monographs and many images as copyrighted; this atlas uses only the page summary text. The raw page is committed at research/snapshots/cg-medlineplus-ldlthebadcholesterol.html.",
            "public_text": "quote"
          }
        },
        {
          "evidence_role": "supports",
          "locator": "Summary, How can a high LDL level raise my risk: \"Coronary artery disease happens when the plaque buildup is in the arteries of your heart.\"",
          "applicability_note": "Links the plaque to coronary artery disease.",
          "snapshot": {
            "id": "cardio:medlineplus-ldlthebadcholesterol-2026-10-14",
            "retrieved_at": "2026-10-14T18:21:46Z",
            "content_hash": "4967a402c8b5c32e8f1757f843be17908505c3b749c98b7001fd7aa8f533d1a6",
            "source_effective_date": null,
            "public_archive_url": null,
            "source_state": "current"
          },
          "source": {
            "id": "cardio:medlineplus-ldlthebadcholesterol",
            "source_type": "webpage",
            "title": "LDL: The Bad Cholesterol (MedlinePlus health topic)",
            "canonical_url": "https://medlineplus.gov/ldlthebadcholesterol.html",
            "identifiers": [],
            "publication_date": null,
            "publisher": "U.S. National Library of Medicine (MedlinePlus)",
            "edition": "Page fetched 2026-10-14.",
            "reuse_basis": "MedlinePlus states that works produced by the federal government are not copyrighted, and lists the summaries on health topic pages and Genetics pages as public domain (the page titled Linking to and Using Content from MedlinePlus, fetched as cg-medlineplus-usingcontent.html, sha256 31267ce9db016893b80c5665312d92ffc8c34ec86916f84708c353936ba52228). It names the A.D.A.M. encyclopedia, drug monographs and many images as copyrighted; this atlas uses only the page summary text. The raw page is committed at research/snapshots/cg-medlineplus-ldlthebadcholesterol.html.",
            "public_text": "quote"
          }
        },
        {
          "evidence_role": "supports",
          "locator": "Page body, What is blood cholesterol",
          "applicability_note": "NHLBI statement about the buildup from high levels of LDL cholesterol.",
          "snapshot": {
            "id": "cardio:nhlbi-blood-cholesterol-2026-10-14",
            "retrieved_at": "2026-10-14T18:21:40Z",
            "content_hash": "29a0ea4dc56eb3191501fac24440448135581637ba8bf06ceae1b0c67c6dc2d7",
            "source_effective_date": null,
            "public_archive_url": null,
            "source_state": "current"
          },
          "source": {
            "id": "cardio:nhlbi-blood-cholesterol",
            "source_type": "webpage",
            "title": "Blood Cholesterol: What Is Blood Cholesterol? (NHLBI)",
            "canonical_url": "https://www.nhlbi.nih.gov/health/blood-cholesterol",
            "identifiers": [],
            "publication_date": null,
            "publisher": "National Heart, Lung, and Blood Institute (NIH)",
            "edition": "Page fetched 2026-10-14. The page footer gives no last-updated date in the fetched text.",
            "reuse_basis": "NHLBI is a US federal agency, but the NIH web policies page returned HTTP 403 to a script on 2026-10-14 (fetched as cg-nih-web-policies.html, sha256 f31e6a4158180b360f81343218dd81bd4338cd6e85ea8de0386fbdc55ce523f7), so the page-level reuse terms were not read and are unverified. Only the hash of the page is kept. Public text is cite_only until the integration owner confirms the terms.",
            "public_text": "cite_only"
          }
        }
      ],
      "review": {
        "content_digest": "c5f9ec7e8d0b9cc6d18933f7108eed1b918bb20eb1e9e6f25f090f26172682fa",
        "current": [],
        "conflicting": [],
        "stale": [],
        "inactive": []
      },
      "api_path": "api/v1/claims/cardio--claim-high-ldl-raises-cad-risk.json"
    }
  ],
  "decisions": [],
  "milestones": [],
  "relationships": {
    "outgoing": [
      {
        "predicate": "increases_risk_of",
        "label": "Raises the risk of coronary artery disease",
        "clinical_claim_not_fact": true,
        "family": "clinical",
        "other_entity_id": "cardio:coronary-artery-disease",
        "other_entity_in_atlas": true,
        "claim_id": "cardio:claim-high-ldl-raises-cad-risk",
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "related_to",
        "label": "A main prevention target",
        "clinical_claim_not_fact": false,
        "family": "navigation",
        "other_entity_id": "cardio:cardiovascular-prevention",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      }
    ],
    "incoming": [
      {
        "predicate": "related_to",
        "label": "Related to",
        "clinical_claim_not_fact": false,
        "family": "navigation",
        "other_entity_id": "core:medlineplus",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "related_to",
        "label": "Related to",
        "clinical_claim_not_fact": false,
        "family": "navigation",
        "other_entity_id": "cardio:pcsk9",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "related_to",
        "label": "Related to",
        "clinical_claim_not_fact": false,
        "family": "navigation",
        "other_entity_id": "cardio:ldl-cholesterol",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "evaluated_for",
        "label": "Evaluated for this",
        "clinical_claim_not_fact": true,
        "family": "clinical",
        "other_entity_id": "cardio:bempedoic-acid",
        "other_entity_in_atlas": true,
        "claim_id": "cardio:claim-clear-outcomes-bempedoic-acid",
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "evaluated_for",
        "label": "Evaluated for this",
        "clinical_claim_not_fact": true,
        "family": "clinical",
        "other_entity_id": "cardio:statins",
        "other_entity_in_atlas": true,
        "claim_id": "cardio:claim-ctt-ldl-lowering-reduces-vascular-events",
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      }
    ]
  },
  "page_path": "risk-factors/high-ldl-cholesterol/",
  "context_path": "api/v1/context/cardio--high-ldl-cholesterol.md"
}