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Michael Meneghini: The Metabolic Picture Behind Cardiovascular Risk

Michael Meneghini/LinkedIn

Sep 14, 2026, 14:50

Michael Meneghini: The Metabolic Picture Behind Cardiovascular Risk

Michael Meneghini, Founder and Chief Executive Officer of Indiana Orthopedic Institute, Professor of Clinical Orthopaedic Surgery at Indiana University School of Medicine, Senior Consultant at OsteoRemedies, LLC and Enovis, shared a post on LinkedIn:

“Cholesterol has a branding problem.

It’s not the villain in your bloodstream.

It’s the reason your cells hold together at all.

Every cell membrane in your body is built with it.

Your hormones need it to exist.

Your liver uses it to make bile so you can digest fat.

Vitamin D doesn’t happen without it.

Your liver makes most of what you need and ships it through your blood packaged as LDL and HDL, dropping it off wherever your body is building something.

The problem was never that cholesterol exists.

The problem shows up in the pattern, not any single number in isolation.

LDL gets most of the attention.

But the fuller picture includes triglycerides and how they stack up against your HDL.

That ratio says as much about your metabolic health as any one cholesterol number does, sometimes more.

Here’s where it connects to my world.

Before I touch a hip or a knee, I need to know what’s happening in that patient’s blood vessels.

Cutting through tissue.

Hours under anesthesia.

Cementing an implant.

Days of reduced mobility after.

That’s real strain on a cardiovascular system.

And the biggest risk after a joint replacement often isn’t the joint.

It’s a clot. Or a cardiac event.

So a lipid panel isn’t paperwork before surgery.

It’s part of the risk calculation that decides how we prepare you, and sometimes whether we operate at all.

Nearly a third of American adults carry high LDL levels (Harvard Health).

But LDL alone rarely tells the whole story.

Research on the triglyceride-to-HDL ratio keeps surfacing it as an independent signal, tied to insulin resistance and metabolic health, not just how much cholesterol is floating around.

Three things worth doing: