Which lipoprotein is considered the dominant atherogenic form of cholesterol in developing ASCVD?

Low-density lipoprotein cholesterol (LDL-C) is recognized as the dominant atherogenic form of cholesterol in the development of atherosclerotic cardiovascular disease (ASCVD). LDL-C particles carry cholesterol from the liver to peripheral tissues, and when elevated, they can penetrate the endothelial lining of blood vessels. This infiltration leads to the accumulation of cholesterol within the arterial wall, promoting the formation of fatty streaks, plaques, and ultimately, atherosclerosis.

The relationship between LDL-C levels and cardiovascular events has been well established through numerous clinical studies. Lowering LDL-C through lifestyle interventions and pharmacotherapy significantly reduces the risk of ASCVD. Thus, LDL-C is often referred to as the "bad" cholesterol because of its strong association with cardiovascular disease.

In contrast, other lipoproteins and triglycerides, while they play roles in lipid metabolism, do not have the same direct impact on atherogenesis as LDL-C. Apolipoprotein B, although important as a marker for atherogenic particles, does not directly represent cholesterol levels, and chylomicrons primarily transport dietary lipids rather than being involved in atherogenesis. Similarly, while triglycerides can be associated with increased cardiovascular risk, they are not considered the primary ather