Thanks for your thoughts, John.

You bring up an important aspect: the LDL-years. Yes, the longer one's exposure to a risk factor (not only LDL, but any risk factor) the greater the risk. That exposure, however, is not considered in the risk algorithms. Those algorithms are made to deal with biomarker snapshots.

Another important caveat to keep in mind is that LDL and most other markers are surrogate markers for the underlying pathophysiological causes of CVD. The most upstream of those causes in chronic low-grade inflammation and endothelial dysfunction. As long as your endothelium is in sterling condition, even elevated LDL won't necessarily do any harm. Unfortunately, we need to live with those surrogates for risk prediction (at least for the time being).