The relationship between baseline plasma lipid levels during acute coronary syndrome and the outcome has clinical relevance. To evaluate their long-term prognostic value we examined 589 patients admitted with acute coronary syndrome at three hospitals. Baseline plasma lipids were assessed on days 1 and 7. Patients were followed for 20 years or until death. Virtually all patients completed follow-up; 437 (74%) had died: 24% due to coronary artery disease/heart failure (CAD/HF), 21% sudden cardiac death (SCD), 16% due to other cardiovascular causes, and 39% due to non-cardiac death. The incidence rate (IR) of all-cause mortality was not different among patients with baseline plasma lipids less or greater than the median value. The IR of CAD/HF mortality was not significantly higher among patients with greater than median LDL and triglyceride levels. The IR of non-cardiac death tended to be lower among patients with greater than median TC and LDL levels. Using three levels of adjusted Cox survival models, baseline plasma lipids had no consistent independent or inverse association with all-cause mortality, even after excluding patients who received statins. Competitive risk survival models for each cause of death revealed that the only hazard of non-cardiac death was consistently higher among patients with less than or equal to median TC and LDL levels. In the present prospective long term study, after acute coronary syndrome, baseline plasma lipid levels seem not to be associated with long-term global mortality. Only an independent inverse association between TC and LDL and non-cardiac death has been observed. This article is protected by copyright. All rights reserved.