STUDY OBJECTIVE: To determine whether preoperative LDL-C concentration affects the risk of perioperative major adverse cardiovascular or cerebrovascular events (MACCE) after noncardiac surgery. DESIGN: Single center retrospective cohort study. SETTING: Hospital (including medical and surgical floor, intensive care unit) and patient disposition location (including the patient's home or any other receiving facility). PATIENTS: 43,348 non-cardiac surgeries at NYU Langone Health between January 2016 and September 2020. INTERVENTIONS: Patients were grouped based on preoperative LDL-C. MEASUREMENTS: Complete serum lipid panel obtained within one year prior to the date of noncardiac surgery and rate of perioperative MACCE, defined as a composite of in-hospital non-fatal myocardial infarction, in-hospital acute ischemic stroke, myocardial injury after noncardiac surgery, and death from any cause within 30 days of surgery. MAIN RESULTS: Perioperative MACCE occurred in 1093 patients (2.5 %) overall. After multivariable adjustment, odds of MACCE were significantly lower in patients with higher (≥100 mg/dL) versus lower (<
100 mg/dL) LDL-C (adjusted odds ratio [aOR] 0.783, 95 % CI, 0.660-0.926]). CONCLUSIONS: In a large cohort of patients undergoing non-cardiac surgery at a major academic health system in New York City, lower LDL-C concentrations were not associated with a lower incidence of perioperative MACCE. Further investigation into modifiable perioperative cardiovascular risk factors is needed to improve perioperative outcomes.