Dutch Lipid Clinic Network low-density lipoprotein cholesterol criteria are associated with long-term mortality in the general population

SummaryBackgroundHeterozygous familial hypercholesterolaemia (HeFH) is a severe autosomal dominant disease that is underdiagnosed, inadequately treated and has a severe long-term cardiovascular risk. Few studies have evaluated the long-term risk of high low-density lipoprotein cholesterol (LDL-C) concentrations.AimTo evaluate long-term mortality in a large cohort of healthy subjects, according to LDL-C concentrations.MethodsBased on a sample of 6956 subjects visiting a preventive cardiology department, we selected adult subjects without a personal history of cardiovascular disease. From 1995 to 2011, 4930 healthy subjects were examined and followed up until 31 December 2011. All-cause deaths were collected exhaustively. A Cox-based multivariable analysis evaluated long-term total mortality risk according to Dutch Lipid Clinic Network (DLCN) LDL-C concentrations.ResultsAfter a mean follow-up of 8.6 years, 123 all-cause deaths were recorded (cumulative mortality rate, 2.5%). In the final multivariable model, major risk factors such as age, sex, tobacco use and diabetes were significantly associated with mortality. After adjustment for age, sex, tobacco use, hypertension, diabetes and statin therapy, and in comparison with subjects with LDL-C<4mmol/L (<155mg/dL), subjects with LDL-C between 4 and <5mmol/L (155 to <190mg/dL) had a hazard ratio (HR) of 1.99 (95% confidence interval [CI] 1.31–3.02; P=0.001), subjects with LDL-C between 5 and <6.5mmol/L (190 to <250mg/dL) had an HR of 1.81 (95% CI, 1.06–3.02; P=0.030), subjects with LDL-C between 6.5 and<8.5mmol/L (250 to