胆固醇风险已远非简单的“好 HDL / 坏 LDL”二分法可以概括：LDL 和 HDL 一起运载体内 80–90% 的循环胆固醇，但约三分之一的心肌梗死和五分之一的中风仍被归咎于 LDL 过多、HDL 过少或二者兼有。新的证据显示，常规的 LDL-胆固醇检测遗漏了最危险的粒子，迫使预防指南去考虑那些单靠饮食、运动和他汀类药物无法完全控制的风险。

大约每 250 人中就有 1 人携带阻断肝脏清除 LDL 的基因缺陷，使其心脏病风险提高约 20 倍，而大约五分之一的人会产生过量载脂蛋白(a)，形成 Lp(a) 颗粒，使其早发性心脏病风险提高数倍，却在常规检验中毫无踪迹。携带的胆固醇往往是典型 LDL 几倍、且单颗致动脉粥样硬化能力可高出四倍的残余脂蛋白，把关注点从“胆固醇量”推向“粒子数”，因此 ApoB 计数如今揭示出 20–30% LDL “正常”但粒子负荷很高、风险被隐藏的人群。

HDL 同样在数字上充满陷阱：提高 HDL-胆固醇的基因变异并不会降低心梗发生率，而极高 HDL 水平（约 3–10% 人群出现）却与更高死亡率以及从糖尿病、脂肪肝到肾病、黄斑变性、阿尔茨海默病和癌症等多种疾病相关。由于体内约 25% 的胆固醇位于大脑、已知与 HDL 相关的蛋白质多达约 280 种、已有 6 项诺贝尔奖授予相关研究、且新的 Lp(a) 靶向药物正在研发，研究者如今把胆固醇视为一个复杂的脂蛋白生态系统，其统计模式而非单一总量更能预测心血管风险。

It's clear that cholesterol risk is more complex than just the "good HDL / bad LDL" narrative. While LDL and HDL account for most circulating cholesterol, there are still significant heart attack and stroke risks associated with imbalances. Recent research suggests that standard tests may overlook the most hazardous particles, prompting changes in prevention guidelines. Additionally, some people have genetic factors that dramatically increase heart disease risk, which isn't typically captured in routine tests.

Remnant lipoproteins can carry significantly more cholesterol than standard LDL, making them much more atherogenic. This shift in focus has led to using ApoB counts to uncover hidden risks in about 20–30% of individuals with “normal” LDL but a high particle burden. The situation with HDL is also tricky; genetic variants that increase HDL levels don't necessarily reduce heart attack risks. In fact, very high HDL levels may correlate with increased mortality and various diseases, highlighting the complexity of cholesterol as a lipoprotein ecosystem.

I need to ensure each paragraph has 1-2 sentences, but it looks like they’re currently too long. The first paragraph is around 68 words, while the second and third are both around 110 words each, giving a total of approximately 288 words. To be safe, I should trim and revise for conciseness. For example, I can shorten the first paragraph, focusing on the fact that cholesterol risk is more complex than simply labeling HDL as "good" and LDL as "bad."