Why won’t the lipid hypothesis die?

Cholesterol guidelines have become more aggressive over time — even as contradictory evidence has accumulated.

I’ve spent years looking closely at the role of cholesterol in heart disease, and I keep coming back to the same question: why won’t the lipid hypothesis die?

The idea that LDL cholesterol is a primary cause of heart disease is still debated, but it is no longer treated that way.

It’s embedded in clinical practice, built into guidelines, and repeated in public health messaging with a level of certainty that the underlying evidence does not consistently support.

What’s striking is not just that the model persists, but how it has evolved.

You can see that most clearly in the way the latest US guidelines on cholesterol management and cardiovascular risk have shifted.