### Consensus consistency validation — 9 October 2026

This is a transparently unblinded consistency check, not a new peer review or an independent blinded audit. The review's frozen cutoff remains **2026-09-29**, and its grade and scorecard counts are preserved.

**Grade:** Ζ / Moderate (unchanged). The review's central wording adds a stronger particle-concentration proposition than LDL-class causality alone. SC4 is the binding subclaim because evidence comparing particle number with cholesterol cargo is heterogeneous and directionally inconsistent. The discovery search's first-ranked European Atherosclerosis Society consensus statement is secondary synthesis and is not treated as primary evidence.

**Frozen scorecard inventory:** 33 evidence rows; 28 claims. The Consensus keyword searches and fetched records are retained as raw JSON in this folder. Search output is discovery metadata; primary claims below are checked against the review's frozen source records and recorded PubMed abstract/metadata inspection.

**Primary comparisons; all already in the original review inventory:**

| PMID / DOI | Source type and ledger role | Original access recorded | Finding and reconciliation |
|---|---|---|---|
| 12066187 / 10.1038/nature00804 | Primary mouse retention-mechanism experiment; SC1 | PubMed abstract and metadata | Altering apoB proteoglycan binding changed atherosclerosis in vivo. Supports a retention mechanism in mice, not human event effect size or the unique causal role of LDL particle count. |
| 16554528 / 10.1056/NEJMoa054013 | Human PCSK9 genetic natural experiment; SC2/SC5 | PubMed abstract and metadata | PCSK9 variants associated with lifelong lower LDL-C and lower CHD risk. Strongly supports LDL-C causality but indexes LDL-C and correlated particle traits together; it cannot adjudicate particle number versus cholesterol cargo. |
| 7968073 / DOI not recorded in the frozen ledger | 4S secondary-prevention randomized trial; SC3/SC5 | PubMed abstract and metadata | Simvastatin reduced major coronary events and mortality in established CHD. Supports LDL-lowering benefit; a statin trial does not separate LDL-P from LDL-C or exclude every drug-specific pathway. |
| 28304224 / 10.1056/NEJMoa1615664 | FOURIER randomized evolocumab outcome trial; SC3/SC5 | PubMed abstract and final metadata | Lower LDL-C with PCSK9 inhibition reduced cardiovascular events. LDL-C, apoB, and LDL-P move together, so the trial does not isolate particle number from cholesterol content. |

These source boundaries reproduce the frozen review's distinction between established LDL-class causality and the more specific number-versus-cargo claim. The fresh Consensus output supplies additional discovery pointers but no independently source-verified finding that resolves the binding discordance question. The score stays Ζ; original sources/claims stay at 33/28.



This dated supplement adds source reconciliation to the original review. Its original narrative, registered scope, source inventory and grades remain historical records. No earlier adversarial approval has been verified for this edition at the supplement date. This provenance supplement has no separate approval and is not an independent or blinded adjudication. New sources described here are supplemental and are not counted in the original inventory.