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The effect of familial combined hyperlipidemia (FCHL) on the risk of future cardiovascular events is unknown. We assessed this question in the Atherosclerosis Risk in the Community (ARIC) Study, a population-based cohort of 15,792 men and women ages 45 to 64 years who were free of major cardiovascular disease (CVD) at enrollment (1987 to 1989) and were followed for incident CVD through 2000. Compared with persons with normal cholesterol levels, the risk of CVD was increased in persons with hypercholesterolemia (LDL > or =190 mg/dL), total cholesterol > or =240 mg/dL, or high-density lipoprotein cholesterol (HDL-C) or =160 mg/dL and total cholesterol > or =240 mg/dL (RR 3.4). Adjustment for CVD at baseline, FCHL, and other conventional risk factors did not change these associations. Compared with persons with normal cholesterol levels, FCHL was associated with increased risk of CVD in men (RR 2.0) but not in women (RR 1.0), and the risk of CVD did not vary by the number of family members with FCHL. However, among persons with FCHL, the RR of CVD associated with HDL-C be359ba680
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