High LDL cholesterol

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.

Also called High bad cholesterol · Raised LDL

Risk factor
In this atlas

Overview

Technical summary

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.

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.

Type: Trait

Contexts

Context 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: Adults. The NHLBI coronary page gives a prevalence for adults aged 20 and older.
Follow-up: Not applicable (descriptive statement)

Eligibility: inclusion criteria not stated; exclusion criteria not stated

Included: None stated
Excluded: None stated

Claims and evidence

Context 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: Adults. The NHLBI coronary page gives a prevalence for adults aged 20 and older.
Follow-up: Not applicable (descriptive statement)

Eligibility: inclusion criteria not stated; exclusion criteria not stated

Included: None stated
Excluded: None stated

Description Evidence stage unknown Certainty not assessed

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.
Applies to Adult
- Adults in general. The pages are written for the public and give no study population, age range or risk group for these statements.
- General health information for the public; no care setting is stated
- United States (pages of US government agencies; some figures on them are US statistics)
- Adults. The NHLBI coronary page gives a prevalence for adults aged 20 and older.
Follow-up Not applicable (descriptive statement)
Certainty method
Not assessed

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.

Last checked
2026-10-14

Next evidence check due
Not scheduled
Sources and citations (3)
1. Supports LDL: The Bad Cholesterol (MedlinePlus health topic)
  
  Webpage · U.S. National Library of Medicine (MedlinePlus) · Edition Page fetched 2026-10-14.
  
  Locator
  Summary, How can a high LDL level raise my risk: "This extra LDL, along with other substances, forms plaque."
  
  How it applies
  MedlinePlus explanation of how high LDL leads to plaque.
  
  Retrieved
  2026-10-14T18:21:46Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  4967a402c8b5c32e8f1757f843be17908505c3b749c98b7001fd7aa8f533d1a6
  
  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.
2. Supports LDL: The Bad Cholesterol (MedlinePlus health topic)
  
  Webpage · U.S. National Library of Medicine (MedlinePlus) · Edition Page fetched 2026-10-14.
  
  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."
  
  How it applies
  Links the plaque to coronary artery disease.
  
  Retrieved
  2026-10-14T18:21:46Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  4967a402c8b5c32e8f1757f843be17908505c3b749c98b7001fd7aa8f533d1a6
  
  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.
3. Supports Blood Cholesterol: What Is Blood Cholesterol? (NHLBI)
  
  Webpage · 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.
  
  Locator
  Page body, What is blood cholesterol
  
  How it applies
  NHLBI statement about the buildup from high levels of LDL cholesterol.
  
  Retrieved
  2026-10-14T18:21:40Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  29a0ea4dc56eb3191501fac24440448135581637ba8bf06ceae1b0c67c6dc2d7
  
  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.

Clinical links

Each link reports what one cited claim says about one population. "Evaluated for" means studied, not shown to work. These links do not show that anything is effective or right for you.

Claim, not a settled fact Raises the risk of coronary artery disease: Coronary artery disease (Associated with a higher risk of)
Applies to Adult
- Adults in general. The pages are written for the public and give no study population, age range or risk group for these statements.
- General health information for the public; no care setting is stated
- United States (pages of US government agencies; some figures on them are US statistics)
- Adults. The NHLBI coronary page gives a prevalence for adults aged 20 and older.
Follow-up Not applicable (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.
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.
Claim, not a settled fact Evaluated for this: Bempedoic acid (Evaluated for, seen from the other side)
Applies to Adult
- Patients unable or unwilling to take statins because of unacceptable adverse effects (statin-intolerant) who had, or were at high risk for, cardiovascular disease (abstract). The registry gives ages 18 to 85 years.
- Multicentre trial (abstract); site list not read
- Multinational: the study record lists every country the registry names
- Adult, 18 to 85 years (registry)
Follow-up Median follow-up 40.6 months (abstract).
In CLEAR Outcomes, 13,970 statin-intolerant patients who had, or were at high risk for, cardiovascular disease took bempedoic acid 180 mg daily (6992) or placebo (6978). Over a median of 40.6 months, the four-component primary composite occurred in 819 patients (11.7%) on bempedoic acid and 927 (13.3%) on placebo (hazard ratio 0.87, 95% CI 0.79 to 0.96). The abstract says there were no significant effects on fatal or nonfatal stroke, death from cardiovascular causes, or death from any cause. Gout (3.1% against 2.1%) and cholelithiasis (2.2% against 1.2%) were more common with bempedoic acid, as were small increases in serum creatinine, uric acid and hepatic-enzyme levels.
Limitations. One randomised, double-blind trial funded by Esperion Therapeutics according to the abstract. The primary composite includes coronary revascularization, which is a softer end point than death. The result is for statin-intolerant people and does not apply to people who tolerate statins. Abstract only.
Claim, not a settled fact Evaluated for this: Statins (Evaluated for, seen from the other side)
Applies to Recipient not specified
- Participants of randomised trials of statin regimens with at least 1000 participants and at least 2 years of treatment: five trials of more versus less intensive statin therapy (39 612 people) and 21 trials of statin versus control (129 526 people). Ages and conditions are not given in the abstract.
- Not stated in the source (abstract only)
- Not stated in the source (abstract only)
- Not stated in the abstract
- Gestational age Not reported
- Postnatal age Not reported
Follow-up Median follow-up 5.1 years in the more-versus-less-intensive trials and 4.8 years in the statin-versus-control trials, as the abstract reports.
An analysis that pooled the data of individual participants from 26 randomised statin trials (about 170,000 participants) found that each 1.0 mmol/L lowering of LDL cholesterol was linked to fewer major vascular events (rate ratio 0.78, 95% CI 0.76 to 0.80) and lower all-cause mortality (rate ratio 0.90, 95% CI 0.87 to 0.93). In the five trials of more versus less intensive statin therapy, a further 0.51 mmol/L LDL reduction at 1 year went with a 15% further reduction in major vascular events (95% CI 11 to 18). The abstract reports no significant effect on cancer incidence (rate ratio 1.00, 95% CI 0.96 to 1.04) and says no threshold was seen within the range studied.
Limitations. Abstract only. This is a pooled analysis by the trialists, funded by public and charitable bodies according to the abstract, of trials of statin regimens, so it says nothing about other LDL-lowering medicines. Effects are per unit of LDL lowering. The abstract does not give the ages or conditions of the participants.

Record details

Record id: cardio:high-ldl-cholesterol
Content hash: bfcfb974cf56faf954ab1c356207553a2470244d0053e508698aa823457fad0c