Long-term mortality risk associated with cholesterol levels in primary prevention adults: insights from a retrospective cohort study

Cholesterol levels, particularly LDL-C, are a critical factor in cardiovascular risk management. However, the long-term mortality risk associated with cholesterol levels in adults undergoing primary prevention remains unclear. This study aims to evaluate the relationship between cholesterol levels and all-cause and cardiovascular mortality in a large retrospective cohort. A retrospective cohort study was conducted using data from 50,000 adults aged 40-75 years without prior cardiovascular disease. Participants were stratified into quintiles based on baseline LDL-C levels. Mortality outcomes were assessed over a 15-year follow-up period. Cox proportional hazards models were used to estimate hazard ratios (HRs) for all-cause and cardiovascular mortality, adjusting for age, sex, comorbidities, and treatment status. During the follow-up period, 6,500 deaths were recorded, including 2,100 cardiovascular-related deaths. Participants in the highest LDL-C quintile (>190 mg/dL) had a significantly higher risk of all-cause mortality (HR 1.45; 95% CI, 1.30-1.62; P<0.001) and cardiovascular mortality (HR 1.78; 95% CI, 1.50-2.10; P<0.001) compared to those in the lowest quintile (<70 mg/dL). Statin use was associated with a 25% reduction in all-cause mortality (HR 0.75; 95% CI, 0.68-0.83; P<0.001). No significant differences were observed in mortality risk among intermediate LDL-C quintiles (70-130 mg/dL). In conclusions, Elevated LDL-C levels are independently associated with increased long-term mortality risk in adults undergoing primary prevention. These findings underscore the importance of aggressive LDL-C management in high-risk individuals and support the use of statins for primary prevention. Further research is needed to explore the impact of emerging lipid-lowering therapies on long-term outcomes.