Being healthy and fit at our age means you are doing something very right. Your cholesterol ratio is also in dark green territory.

I'm generally not so fond of the current practice of tunnel vision on individual risk factors. The reason becomes clear when you look at the pathogenesis of a heart attack, for example. An infarct happens when blood supply to an area of the heart muscle is interrupted for a certain amount of time (a few minutes). Without the oxygen supply the afflicted muscle cells die. That's basically what a heart attack is. Now, there are several things that need to happen in sequence. First, a blood clot must form. Typically that happens when an atherosclerotic plaque ruptures so that the inner core of the plaque is exposed to the bloodstream. This clot must dislodge and travel downstream, where it then gets stuck at a site where it can't pass through the narrowing artery or arteriole. If fibrinolysis is activated in time to dissolve the clot nothing bad happens. So, all these events must happen i sequence: clotting, dislodging of the clot, obstruction and lack of timely dissolution (fibrinolysis). The perfect storm, so to speak.

We know that atherosclerotic plaques can be present already during adolescence or young adulthood. We also know that vulnerable plaques often silently break up and produce blood clots, and that most of the time fibrinolysis kicks in in time to prevent the dramatic event. So, in a way, the whole scenario is a game of chance. Reducing cholesterol reduces the number of atherosclerotic plaques. With fewer plaques around, the chances of clot formation are reduced, etc. That's why my favorite strategy (for me and my clients) is to minimize all the risk points along the path of "perfect storm" formation. Cholesterol is just one node on that path.