BACKGROUND: Individuals with familial hypercholesterolemia (FH) are at high risk of developing cardiovascular disease due to high LDL cholesterol concentrations. Other cardiovascular risk factors may add to this risk. METHODS: We used Dutch Lipid Clinic Network (DLCN) criteria to diagnose FH in 106,865 individuals from the Copenhagen General Population Study. The importance of cardiovascular risk factors on i) assignment to DLCN FH-categories
ii) risk of myocardial infarction (MI) within each DLCN FH-category
and iii) the absolute ten-year risk of atherosclerotic cardiovascular disease (ASCVD) in DLCN FH-categories was investigated. RESULTS: Risk of being diagnosed with possible or probable FH was higher in individuals who smoked, had hypertension, a body mass index (BMI)≥30kg/m CONCLUSION: The likelihood of being diagnosed with FH by the DLCN criteria was influenced by smoking, hypertension, BMI, and triglyceride and lipoprotein(a) concentrations in the general population. For individuals within the same possible or probable FH-category, age, male sex, smoking, hypertension, and diabetes independently added to the risk of MI and ASCVD.