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Between randomized trials and Mendelian randomization studies, all of the causal tools demonstrate that LDL is a causal biomarker. (There are other elements in the causal pathway, but very clearly LDL is one of them.)

You are welcome to postulate a different explanation and test that novel mechanism, which is the process of science.

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There are numerous examples of people with elevated LDL for years who have zero CAC or no cardiac symptoms. It’s easier to disprove something I admit.

I am still in the process of becoming learned. Eventually I will finish biochemistry, read all the relevant studies and truly get to the bottom of it in a way that is convincing. So even if I am wrong and spreading wrong information I will have a positive contribution in the long term. But I am being intellectually honest always.

The fact that LDL cholesterol is not the only risk factor for heart disease is very well established - just as well established as the fact that LDL cholesterol is a causal risk factor for heart disease. Unfortunately human diseases almost never have a bijective relationship with a risk factor.

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