Three quarters of heart attack patients had "normal" cholesterol

Researchers at UCLA checked that assumption against a national registry of 136,905 people hospitalized for a heart attack at 541 hospitals, looking at the cholesterol levels each patient had on admission, before any treatment.

Nearly half of the patients had LDL levels below 100 mg/dL, the threshold then considered optimal, and close to three quarters fell within ranges the era's guidelines did not classify as high risk. More than half also had low HDL, the protective cholesterol, a pattern the standard risk tools largely missed.

The study did not argue cholesterol was irrelevant, but that the specific cutoffs used to flag high-risk patients were missing most of the people who went on to have heart attacks. It pushed cardiology toward looking beyond a single LDL number, toward particle type, inflammation markers and overall risk scores, though no single replacement test has fully taken over.

The warning sign missed most of its targets.