{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T01:43:16Z","timestamp":1792633396628,"version":"4.5.0"},"reference-count":44,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Limited evidence supports the association between low-density lipoprotein cholesterol (LDL-C) and mortality across different atherosclerotic cardiovascular disease (ASCVD) risk stratifications.<\/jats:p><\/jats:sec>Objective<\/jats:title>To explore the associations between LDL-C levels and mortality and to identify the optimal ranges of LDL-C with the lowest risk of mortality in populations with diverse ASCVD risk profiles.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>The ChinaHEART project is a prospective cohort study that recruited residents aged 35 to 75 years from 31 provinces in mainland China between November 2014 and December 2022. Participants were categorized into low-risk, primary prevention, and secondary prevention cohorts on the basis of their medical history and ASCVD risk. Data analysis was performed from December 2022 to October 2023.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary end point was all-cause mortality, and secondary end points included cause-specific mortality. Mortality data were collected from the National Mortality Surveillance System and Vital Registration. The association between LDL-C levels and mortality was assessed by using Cox proportional hazard regression models with various adjusted variables.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 4\u202f379\u202f252 individuals were recruited, and 3\u202f789\u202f025 (2\u202f271\u202f699 women [60.0%]; mean [SD] age, 56.1 [10.0] years) were included in the current study. The median (IQR) LDL-C concentration was 93.1 (70.9-117.3) mg\/dL overall at baseline. During a median (IQR) follow-up of 4.6 (3.1-5.8) years, 92\u202f888 deaths were recorded, including 38\u202f627 cardiovascular deaths. The association between LDL-C concentration and all-cause or cardiovascular disease (CVD) mortality was U-shaped in both the low-risk cohort (2\u202f838\u202f354 participants) and the primary prevention cohort (829\u202f567 participants), whereas it was J-shaped in the secondary prevention cohort (121\u202f104 participants). The LDL-C levels corresponding to the lowest CVD mortality were 117.8 mg\/dL in the low-risk group, 106.0 mg\/dL in the primary prevention cohort, and 55.8 mg\/dL in the secondary prevention cohort. The LDL-C concentration associated with the lowest all-cause mortality (90.9 mg\/dL vs 117.0 mg\/dL) and CVD mortality (87 mg\/dL vs 114.6 mg\/dL) were both lower in individuals with diabetes than in individuals without diabetes in the overall cohort.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This study found that the association between LDL-C and mortality varied among different ASCVD risk cohorts, suggesting that stricter lipid control targets may be needed for individuals with higher ASCVD risk and those with diabetes.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.22558","type":"journal-article","created":{"date-parts":[[2024,7,18]],"date-time":"2024-07-18T15:02:59Z","timestamp":1721314979000},"page":"e2422558","source":"Crossref","is-referenced-by-count":84,"title":["Low-Density Lipoprotein Cholesterol, Cardiovascular Disease Risk, and Mortality in 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