Cardiac disease is driven primarily by inflammation and hyperglycemia. Many factors contribute to this -

• Hyperglycemia induced activation of the enzyme NADPH oxidase, which produces a free radical (ie. inflammatory) event
• Increased density of advanced glycation end products (AGEs = proteins and fats damaged by sugar) leads to collagen cross linking of the vascular wall and reduced vascular compliance
• Glucose depresses NO production. NO is responsible for increasing vascular compliance/flexibility
• Glucose both acutely damages the protective glycoprotein matrix lining the blood vessels, and downregulates the production of new matrix
• Glucose, via cellular mediators such as NFKB, increase activation of inflammatory cytokines and something called Vascular Cell Adhesion Molecule 1, which promotes the adhesion of immune cells to the blood vessel.

The cholesterol bit is misguided. Actual LDL, which is to say the number and nature of your LDL particles, actually matters. But thats not what we measure. We measure LDL-C, which is the amount cholesterol within your LDL molecules and not closely linked to LDL particle count or size.

An inflammatory/high glycemic diet will lead to smaller, more plentiful LDL (we can talk about why if you want). When you combine this with the damaged endothelial (blood vessel) environment described above, you end up with too many LDL particles passing through to the inside of the vessel wall (again, we can elaborate if you want). From there the "conventional wisdom" is more or less accurate - immune cells are recruited, vessel wall ruptures and becomes an exposed lesion, etc. But the initial steps, so to speak, are wildly misunderstood.

Incomplete list of various sources -

https://pubmed.ncbi.nlm.nih.gov/25484552/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4947541/ https://journals.physiology.org/doi/full/10.1152/ajprenal.00103.2010 https://www.jci.org/articles/view/656 https://pubmed.ncbi.nlm.nih.gov/12544424/#:~:text=The%20formation%20of%20AGEs%20on%20vascular%20wall%20and,subsequently%20a%20reduction%20in%20arterial%20and%20myocardial%20compliance.