A 55-year-old patient with borderline high LDL asks whether eliminating dietary cholesterol will meaningfully lower his cardiovascular risk. Which response most appropriately evaluates the situation and guides clinical decision-making?

• A. Reassure him that LDL is irrelevant and that dietary changes are unnecessary because the liver completely controls circulating LDL independently of dietary inputs.
• B. Recommend strict lifelong avoidance of all dietary cholesterol for everyone of his age because dietary cholesterol is the single determinant of LDL and cardiovascular risk, overriding all other lifestyle factors.
• C. Advise consuming more dietary cholesterol to stimulate hepatic cholesterol synthesis downregulation and thereby paradoxically reduce LDL for all individuals without need for follow-up testing.
• D. Explain that LDL is a significant risk factor, but reducing dietary cholesterol alone has variable effects on LDL; emphasize lowering saturated and trans fats, weight control, physical activity, and, if needed, targeted lipid-lowering therapy based on overall risk profile rather than universally eliminating cholesterol-rich foods alone.

Answer: (D)