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ABSTRACT: Objective
To determine the association between levels of low density lipoprotein cholesterol (LDL-C) and all cause mortality, and the concentration of LDL-C associated with the lowest risk of all cause mortality in the general population.Design
Prospective cohort study.Setting
Denmark; the Copenhagen General Population Study recruited in 2003-15 with a median follow-up of 9.4 years.Participants
Individuals randomly selected from the national Danish Civil Registration System.Main outcome measures
Baseline levels of LDL-C associated with risk of mortality were evaluated on a continuous scale (restricted cubic splines) and by a priori defined centile categories with Cox proportional hazards regression models. Main outcome was all cause mortality. Secondary outcomes were cause specific mortality (cardiovascular, cancer, and other mortality).Results
Among 108?243 individuals aged 20-100, 11?376 (10.5%) died during the study, at a median age of 81. The association between levels of LDL-C and the risk of all cause mortality was U shaped, with low and high levels associated with an increased risk of all cause mortality. Compared with individuals with concentrations of LDL-C of 3.4-3.9 mmol/L (132-154 mg/dL; 61st-80th centiles), the multivariable adjusted hazard ratio for all cause mortality was 1.25 (95% confidence interval 1.15 to 1.36) for individuals with LDL-C concentrations of less than 1.8 mmol/L (<70 mg/dL; 1st-5th centiles) and 1.15 (1.05 to 1.27) for LDL-C concentrations of more than 4.8 mmol/L (>189 mg/dL; 96th-100th centiles). The concentration of LDL-C associated with the lowest risk of all cause mortality was 3.6 mmol/L (140 mg/dL) in the overall population and in individuals not receiving lipid lowering treatment, compared with 2.3 mmol/L (89 mg/dL) in individuals receiving lipid lowering treatment. Similar results were seen in men and women, across age groups, and for cancer and other mortality, but not for cardiovascular mortality. Any increase in LDL-C levels was associated with an increased risk of myocardial infarction.Conclusions
In the general population, low and high levels of LDL-C were associated with an increased risk of all cause mortality, and the lowest risk of all cause mortality was found at an LDL-C concentration of 3.6 mmol/L (140 mg/dL).
SUBMITTER: Johannesen CDL
PROVIDER: S-EPMC7722479 | biostudies-literature | 2020 Dec
REPOSITORIES: biostudies-literature
Johannesen Camilla Ditlev Lindhardt CDL Langsted Anne A Mortensen Martin Bødtker MB Nordestgaard Børge Grønne BG
BMJ (Clinical research ed.) 20201208
<h4>Objective</h4>To determine the association between levels of low density lipoprotein cholesterol (LDL-C) and all cause mortality, and the concentration of LDL-C associated with the lowest risk of all cause mortality in the general population.<h4>Design</h4>Prospective cohort study.<h4>Setting</h4>Denmark; the Copenhagen General Population Study recruited in 2003-15 with a median follow-up of 9.4 years.<h4>Participants</h4>Individuals randomly selected from the national Danish Civil Registrat ...[more]