A recent post by Dr Shailesh Singh on X (formerly known as Twitter) has caught attention for a simple reason. It questions a belief many people hold tight. The belief is that a single LDL cholesterol number tells the full heart health story. According to the doctor, this number gives comfort when it should raise questions. The reason lies in how cholesterol is measured and how heart disease actually begins. This is not about fear. It is about understanding the biology behind the report.
LDL cholesterol is a concentration, not a count
The LDL value on a standard lipid test shows concentration. It tells how much cholesterol is being carried in the blood. It does not tell how many LDL particles are doing the carrying. Dr Singh explains this with a clear picture. LDL particles act like delivery trucks. Some trucks are big and full. Others are small and only partly filled. Two people can carry the same total load but use a very different number of trucks. The report shows the load, not the traffic.
Same LDL number, very different heart risk
This is where confusion begins. One person may have an LDL-C of 130 mg/dL with many small, dense particles. Another may have the same LDL-C with fewer, larger particles. The lab report looks identical. The risk is not. Each LDL particle has the chance to enter the artery wall. More particles mean more chances for trouble. This explains why people with similar reports can have very different outcomes over time.
What happens inside the artery wall
When an LDL particle enters the artery wall, it does not sit quietly. It triggers inflammation. The body reacts as if there is damage. Over time, repeated events lead to plaque formation. Dr Singh highlights a key point here. Risk rises with the number of particle entry events, not just with how much cholesterol is present. More particles mean more inflammation, and more inflammation means higher chances of atherosclerosis.
Why standard lipid panels can miss the real story
A routine lipid panel is useful, but it has limits. It does not measure particle number. This becomes important in people with insulin resistance, metabolic syndrome, or high triglycerides. In such cases, LDL particles are often smaller and denser. That usually means a higher particle count even when LDL-C looks acceptable. The report may say “within range,” while the arteries tell a different story.
Treating biology, not just lab numbers
Dr Singh points to tests that align better with biology. LDL-P measures the number of LDL particles directly using advanced methods. Apo B offers another clear signal, as each LDL particle carries one Apo B protein. These markers focus on what actually drives plaque formation. This shift is about understanding risk, not chasing perfect numbers. It adds context, not confusion, to heart health decisions.Disclaimer: This article is for general information only. It does not replace medical advice, diagnosis, or treatment. Cholesterol testing and heart risk assessment should always be discussed with a qualified healthcare professional, based on individual health history and needs.
