Why is insulin resistance a more informative cardiometabolic biomarker than LDL cholesterol (LDL-C)?

Insulin resistance is more informative because it explains the full cardiometabolic risk pattern, including glycaemic instability, elevated triglycerides, hypertension, inflammation, and progression to type 2 diabetes. LDL-C, by contrast, measures only the cholesterol content within LDL particles and does not reliably reflect risk in isolation; individuals with identical LDL-C values can have very different particle numbers and risk profiles.

Cholesterol-centred models became dominant because cholesterol was measurable early and served as a convenient surrogate target. However, LDL particles exist to transport cholesterol for essential physiological functions, and there is no fixed cholesterol content per LDL particle. Treating LDL-C as the primary causal driver can therefore obscure upstream metabolic dysfunction, particularly insulin resistance and triglyceride dysregulation, that better explains contemporary cardiovascular disease risk.

Why is insulin resistance a more informative cardiometabolic biomarker than LDL cholesterol (LDL-C)?

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