High LDL Raises Mortality Risk, Even in Low-Risk Patients

Patients who are at low risk for cardiovascular disease (CVD) but who have low-density lipoprotein (LDL) cholesterol levels above 160 have increased long-term mortality risk, according to the results of a recent study.


In an attempt to determine the long-term associations of various levels of LDL-C and non-high-density lipoprotein cholesterol (HDL-C) with CVD and coronary heart disease mortality, researchers conducted a study involving 36,375 participants with low 10-year risk of atherosclerotic CVD events.


Baseline LDL-C Levels Impact Effectiveness of CVD Risk Reduction

The Novel Method: A More Personalized Method for Assessing LDL

Overall, 1086 CVD and 598 coronary heart disease deaths occurred. Compared with patients with LDL-C <100 mg/dL, LDL-C categories 100 to 129 mg/dL, 130 to 159 mg/dL, 160 to 189.9 mg/dL, and ≥190 mg/dL were associated with a significantly higher risk of CVD death (hazard ratios: 1.4, 1.3, 1.9, and 1.7, respectively).


Following adjustments for atherosclerotic risk factors, LDL-C categories 160 to 189 mg/dL and ≥190 mg/dL remained independently associated with CVD mortality (hazard ratios: 1.7 and 1.5, respectively).


When non-HDL-C <130 mg/dL was used as a reference, non–HDL-C 160 to 189 mg/dL, 190 to 219 mg/dL, and ≥220 mg/dL were significantly associated with CVD death, (hazard ratios: 1.3, 1.8, and 1.5, respectively).


“In a low 10-year risk cohort with long-term follow-up, LDL-C and non–HDL-C ≥160 mg/dL were independently associated with a 50% to 80% increased relative risk of CVD mortality. These findings may have implications for future cholesterol treatment paradigms,” the researchers concluded.


—Michael Potts



Abdullah SM, Defina LF, Leonard D, et al. Long-term association of low-density lipoprotein cholesterol with cardiovascular mortality in individuals at low 10-year risk of atherosclerotic cardiovascular disease [published online August 16, 2018]. Circulation. doi: 10.1161/CIRCULATIONAHA.118.034273.