Which lipoprotein is the most atherogenic lipid and the primary marker of coronary heart disease?

• A. LDL
• B. HDL
• C. VLDL
• D. Lp(a)

Answer: (A)

Low-density lipoprotein (LDL) is the lipoprotein most linked to atherogenesis because it transports cholesterol into the arterial wall. When LDL infiltrates the intima and becomes oxidized, it triggers inflammation and is taken up by macrophages, forming foam cells and driving the development of atherosclerotic plaques. This direct role in plaque formation makes it the strongest contributor to coronary heart disease risk, and clinically, LDL cholesterol levels are the primary lipid marker used to assess risk and guide therapy.

In contrast, HDL helps remove cholesterol from the vessel wall and is generally protective, while VLDL and its remnants mainly carry triglycerides and contribute to risk but not as directly as LDL. Lp(a) is an LDL-like particle with extra apolipoprotein(a); it raises risk in some individuals but is treated as a separate risk modifier rather than the main marker of CHD.