Study: Young adults with high cholesterol face greater risk of heart attack or stroke
Young adults who take cholesterol-lowering drugs or make healthy lifestyle changes might avoid heart disease or strokes later in life, according to a new study.
A large study published in The Lancet medical journal this week reported adults with high levels of bad cholesterol at age 45 had a greater risk of heart disease or stroke at age 75 than older adults with similar cholesterol levels.
Because doctors are more likely to track cholesterol levels in middle-aged or older adults and consider a person’s risk for heart disease or stroke over 10 years, they might “underestimate lifetime risk, particularly in young individuals,” the study’s authors said.
Nearly 650,000 Americans died of heart disease in 2017, which makes it the nation's leading cause of death. More than 146,000 died of stroke, the fifth-leading cause of death, according to Centers for Disease Control and Prevention data.
The paper, released Tuesday, analyzed data from 38 studies tracking nearly 400,000 people in Europe, North America and Australia from 1970 through 2013. Study participants were followed over a median of 13.5 years.
More: Taking blood pressure medicine at this time of day may lower stroke, heart attack risk
More: Taking blood pressure medicine at this time of day may lower stroke, heart attack risk
A person age 45 who lowered non-HDL cholesterol by 50% had a lower risk of heart attack or stroke by age 75. Heart disease and strokes were three to four times higher in men and women who had the highest levels of non-HDL cholesterol, a measure of total cholesterol excluding HDL cholesterol.
James de Lemos, a professor of medicine at the University of Texas Southwestern Medical Center and a co-author of the study, said the research identifies non-HDL cholesterol as a crucial target for doctors and patients to monitor.
He said the paper, combined with earlier studies, supports the idea of monitoring cholesterol in young adults and encouraging lifestyle changes or cholesterol-lowering statins to reduce a person's lifetime risk of heart disease.
"If you get this risk factor, non-HDL, treated earlier, you can really make a difference in the long-term trajectory in people," de Lemos said.
But the study's authors acknowledge they don't know whether early treatment would be more effective. There are no clinical studies measuring how young adults who receive statins or other cholesterol-lowering drugs before age 45 fare decades later.
"What’s missing is the clinical trials that show favorable risk-benefit and cost-benefit from treating people younger because their short term risk is lower," de Lemos said. "I would argue that it would be very difficult to ever have those studies. The size and scope of a primary prevention study in young people would be overwhelming."
Dr. Robert McLean, president of the American College of Physicians, said the Lancet paper uses a model to predict a person’s risk of developing cardiovascular disease by age 75.
It’s unlikely the group will use the study to develop recommendations for internal medicine doctors and patients. The physicians group develops such recommendations from clinical trials, which compare groups of patients to assess whether a drug or other treatment is safe and effective.
Still, some doctors might find the study useful, he said.
“Clinicians frequently find such risk estimating tools helpful to give patients numbers to understand when some of the statistics can frequently be complicated,” McLean said.
Roger Blumenthal is the director of Johns Hopkins' Ciccarone Center for the Prevention of Cardiovascular Disease. He also helped author the American College of Cardiology and American Heart Association guideline on cholesterol management.
The groups recommend adults ages 20 to 39 maintain heart health through exercise and a healthy diet with foods such as vegetables, fruits, whole grains, nuts and low-fat proteins. For older adults, the guideline recommends doctors and patients discuss risks such as cigarette smoking, high blood pressure and cholesterol levels before deciding whether to taking medication.
"The patient has the final say," Blumenthal said. "What a clinician needs to do is provide them the best available evidence. This article is one I will personally use in talking to patients."
This article originally appeared on USA TODAY: Millennials with high cholesterol risk heart disease, stroke
