Value of Total Cholesterol Readings Earlier Versus Later in Life to Predict Cardiovascular Risk

Background: Prognostic implications of blood cholesterol may differ at different stages of life. This cohort study compares the value of total cholesterol (TC) readings earlier versus later in life to predict coronary atherosclerosis, cardiovascular events, and cardiovascular death. Methods: In a cardiovascular observation study (CVOS) we performed coronary angiography and prospectively recorded cardiovascular events in 1090 patients over up to 19 years. These patients had participated in a health survey 15 years prior to the CVOS baseline. TC was measured both at the earlier health survey and at the later CVOS recruiting. Findings: Patients in the highest versus the lowest TC-category of the health survey had an OR of 4.30 [2.41-7.65] for significant CAD at angiography, a HR of 1.74 [1.10-2.76] for cardiovascular events, and a HR of 7.55 [1.05-54.49] for cardiovascular death after multivariate adjustment. In contrast, TC as measured at the baseline of the CVOS was neither significantly associated with significant CAD nor with cardiovascular events or death during follow-up. In addition, the ESC/EAS-SCORE was found to be more powerful in predicting cardiovascular mortality when using earlier instead of later TC, with a continuous net reclassification improvement of 0.301 (p<0.001). Interpretation: Early measurement not only enables early diagnosis and therapy in the context of the concept of lifelong exposure to atherogenic lipoproteins. This data also suggest that cardiovascular risk prediction is more accurate if using earlier in life TC readings. Funding: The present study did not receive any particular funding Declaration of Interest: None to declare. Ethical Approval: The present study conforms to the ethical guidelines of the 1975 Declaration of Helsinki and has been approved by the Ethics Committee of Vorarlberg, Austria, and the University of Innsbruck, Austria. All participants gave written informed consent.