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LDL cholesterol, often referred to as "bad" cholesterol, is considered harmful primarily due to its association with the development of atherosclerosis. Atherosclerosis is a condition where plaque, which is a buildup of fat, cholesterol, and other substances, accumulates in the walls of arteries. This can lead to narrowing and hardening of the arteries, ultimately increasing the risk of heart disease and stroke.

LDL cholesterol contributes to this plaque buildup because it is involved in transporting cholesterol from the liver to the cells and tissues throughout the body. When there is an excess of LDL in the bloodstream, it can lead to an accumulation of cholesterol in the arterial walls. Unlike HDL cholesterol, which is known for its beneficial role in removing excess cholesterol from the blood and transporting it back to the liver for excretion, LDL has the opposite effect. Therefore, higher levels of LDL cholesterol are linked to an increased risk of cardiovascular events.

While triglycerides and VLDL cholesterol can also impact heart health, they are not primarily identified as the main contributors to plaque formation in the same way as LDL cholesterol. Thus, focusing on managing LDL levels is crucial for reducing cardiovascular risk.