The recent change in thinking has to do with results from trials in which medications which lowered the cholesterol to acceptable lfailed to show improved cardiovascular outcomes. Hence I think what we should follow is what we have learned from all of the primary and secondary cardiovascular morbidity trials, which is generally that if you use a statin in low, medium and high risk groups for cardiovascular outcomes, then the risk is diminished by a rate that is proportional to their risk for CAD. This is not true in other classes of dyslipidemic medications in general. So I believe in the statins, and it likely has more to do with reverse cholesterol transport and decrease of endothelial cholesterol and inflammation than cholesterol levels per se.
I do think that maintaining a recommended ldl profile is important, but HDL and the ratio of hdl to total cholesterol are also important. I think that they have known this since the 50's, but not exactly why.
I just look at coronary plaques as scaring from zits that you get on the inside of your arteries that start out about the same as what you would get on your face. We all know that cleaning the oils, which are basically cholesterol, from your face will prevent these from forming. When they do, it's inflamation, with a vicous liquid interior. That interior is a mix of bacteria and cholesterol based oils. Scratch them enough and you will get a scar. These scars in you coronary arteries continue to get inflamed, infected, break and build up over time. This is not based on any medical fact or research of my own. I've just sort of divined this vision of my coronary plaques over time.
So the root cause of the inflamation is a combination of lipids sticking to the arterial walls and combining with bacteria in my vision of how my disease got started.
I changed my lipid profile from 230 total with only 30 HDL to consistent to 139 TC / 65 HDL / 57 LDL / 83 TRI on my last checkup. I've been in that ballpark for the last 9 years or so and am a believer that it's one of the 3 main reasons that I have had no further cardiac events and have lived a normal life during that time. I take 3 drugs in combo: Lipitor, Niaspan, and Welchol.
Another thing that I did early on, to address what I thought was a root cause of my disease (and inflamation), was to take a strong round of a frontline antibiotic. I planned 3 months of Zithromax, but had to quit after about 5 weeks as it evidently killed every bug in my body, including the good ones. Did it work? Don't know? The studies on that were inconclusive.
In my book, your HDL level is the primary predictor of coronary artery disease and longevity in general.