Let's get one thing perfectly clear right from the outset: atherosclerotic plaques are not simply big wads of fat and cholesterol that have stuck to the walls of arteries like mud inside a pipe. That so many supposedly intelligent people have even contemplated entertaining such a notion, let alone accepted it as gospel truth, is a sad, sad reflection of the extremely low intellectual standard dominating the health sciences, and society in general, today.
The growth of atherosclerotic plaques begins inside the artery wall, between the inner and outer layers. These plaques are actually complex entities comprised of numerous components, including smooth muscle cells, calcium, connective tissue, white blood cells, and cholesterol and fatty acids. The proliferation of these various components occurs, not because of elevations in blood cholesterol or because one has eaten too much butter and cream, but because of unfavorable physiological conditions that damage or weaken the structure of the artery. This triggers an inflammatory state in which the body recognizes the injury and sets about to repair it. Cholesterol is present in atherosclerotic plaque for the same reason all the other components are present--as part of the body's attempt to repair itself. Blaming cholesterol for atherosclerotic plaque makes about as much sense as blaming paramedics for the carnage they are faced with after arriving at the scene of an accident.
This 'response-to-injury' scenario is well accepted by the vast majority of serious cardiovascular researchers. The problem is that many of these same individuals insist on clinging to the untenable notion that LDL cholesterol is somehow involved in triggering or aggravating the inflammatory state that promotes atherosclerosis and eventually leads to heart disease or stroke.