Low-density lipoprotein cholesterol (LDL-C) is widely recognized as a significant risk factor for cardiovascular disease (CVD) according to recent studies and guidelines.
LDL-C and cardiovascular risk
- LDL-C and CVD: Elevated levels of LDL-C contribute to the development of atherosclerosis, characterized by the accumulation of lipid-laden plaques within arterial walls, leading to reduced blood flow and increased risk of myocardial infarction, stroke, and peripheral artery disease.
- LDL-C reduction and CVD risk: Interventional studies have shown that lowering LDL-C levels results in a proportional reduction in CVD risk. Each 1 mmol/L reduction in LDL-C is associated with a roughly 20–25% decrease in major vascular events
- LDL-C and coronary heart disease (CHD): A cohort study demonstrated that cumulative LDL-C and time-weighted average LDL-C during young adulthood and middle age are associated with the risk of incident CHD, independent of midlife LDL-C level
- LDL-C and cardiovascular mortality: In a low 10-year risk cohort with long-term follow-up, LDL-C and non-HDL-C levels ≥160 mg/dL were independently associated with a 50% to 80% increased relative risk of CVD mortality
LDL-C assessment in guidelines
- ACC/AHA guidelines: The ACC/AHA 2014 guidelines recommend assessing cardiovascular risk using global risk scores such as the Framingham Risk Score in asymptomatic adults without a clinical history of coronary artery disease (CAD)
- SOGC guidelines: The SOGC 2014 guidelines recommend obtaining lipid profile screening in females aged 50–75 every 3–5 years for cardiovascular risk assessment
- CCS guidelines: The CCS 2016 guidelines recommend screening for dyslipidemia with nonfasting lipid and lipoprotein testing in adult patients undergoing cardiovascular risk assessment
- EAS/ESC guidelines: The EAS/ESC 2020 guidelines recommend obtaining total cholesterol for the estimation of total cardiovascular risk by means of the SCORE system
In conclusion, LDL-C is a significant risk factor for CVD, and its assessment is recommended in various guidelines for cardiovascular risk assessment.