A “reader’s comment” on an opinion piece by William C. Roberts in the American Journal of Cardiology, kindly published by the editor. Roberts’ editorial focuses on the large body of evidence favoring the cholesterol hypothesis and laments what he considers the distracting effect of complementary hypotheses (eg. inflammation, “multifactorial” nature of atherosclerosis, etc.). I offer a few points regarding the difficulties of dealing with strictly risk-based diagnoses that rely on arbitrary cut-off numbers and have no defining pathological correlates. Unfortunately not free online, but I’m happy to provide reprints upon request.