LDL concentration is the wrong question
LDL cholesterol — low-density lipoprotein — is the classic 'bad cholesterol' marker. The standard upper limit is typically 3.0 mmol/L (116 mg/dL). Above this, you're flagged. But LDL concentration is a poor proxy for cardiovascular risk compared to what researchers now understand about lipid biology. The real question isn't how much cholesterol is in your LDL particles. It's how many LDL particles there are.
ApoB: the marker that actually matters
Small, dense LDL particles are more atherogenic — more likely to enter arterial walls and contribute to plaque — than large, buoyant LDL particles. Two people can have identical LDL-C but very different cardiovascular risk profiles depending on their particle size and number. ApoB is the best single marker for this. ApoB is a protein found on every atherogenic lipoprotein particle — LDL, VLDL, IDL, Lp(a). One ApoB per particle. So ApoB directly measures particle number. The optimal ApoB for most people is below 0.8 g/L. Above 1.0 g/L, the evidence for intervention strengthens significantly.
Why athletes often have elevated LDL without elevated risk
Athletes often have elevated LDL for reasons unrelated to cardiovascular risk. High saturated fat intake — common in athletes following higher fat dietary approaches — raises LDL. In many cases this elevation is in large, buoyant particles. ApoB in these individuals may be entirely normal despite elevated LDL-C. The lean mass hyper-responder (LMHR) phenotype describes athletes who dramatically elevate LDL on low-carbohydrate diets — sometimes to 5–7 mmol/L — while maintaining low triglycerides and high HDL. Whether this represents elevated risk is actively debated in the research. ApoB is the key additional data point.
The full lipid picture
HDL is the other piece. High HDL — above 1.6 mmol/L in males — is associated with better cardiovascular outcomes. Triglycerides below 1.0 mmol/L, combined with high HDL, paint a very different risk picture than triglycerides of 2.5 mmol/L with low HDL — even at the same LDL level. Get ApoB tested. Understand your full lipid picture before making medication decisions based on LDL alone.