HEART
February 9, 2015

Not So Young at Heart

High cholesterol begins to take its toll at an early age. Damage can start in your 20s.

You don't find too many young adults worrying about their cholesterol — most think it only becomes important later in life. But a new study suggests that every decade you live with high cholesterol increases your risk of heart disease by almost 40 percent.

High cholesterol is like smoking. “The number of years with elevated cholesterol, or ‘lipid years,’ can affect you in a similar way to the number of ‘pack years’ you have had as a smoker...What we're doing to our blood vessels in our 20s, 30s and 40s is laying the foundation for disease that will present itself later in our lives,” said study's lead author, Ann Marie Navar-Boggan, in a statement.

“If we wait until our 50s or 60s to think about cardiovascular disease prevention, the cat's already out of the bag.”

Researchers examined the records of 1,478 adults from the Framingham Heart Study, which began in 1948 and continues to this day. All were free of heart disease at age 55. These people were then followed for up to 20 years longer to see how their cholesterol level affected their risk of contracting heart disease.

The study results suggest that 35-55-year-olds with high cholesterol who are otherwise healthy might benefit from statins.

People whose cholesterol was high at age 45 or younger were nearly four times as likely to develop heart disease by the time they were 70.

For the purposes of the study, Cholesterol (High) was defined as non-HDL cholesterol [LDL and very-low-density lipoprotein (VLDL) combined] of 160 mg/dL or higher. The researchers found similar results for patients with LDL (bad) cholesterol of 130 mg/dL or higher.

Each decade of living with high cholesterol raised the risk of heart disease by 39%.

Most of the younger study participants with high cholesterol would not qualify for treatment with statins under today's guidelines, but the study results suggest that 35-55-year-olds with high cholesterol who are otherwise healthy might benefit from them. Navar-Boggan cites the need for more data on the long-term effectiveness and safety of statins in younger adults to show whether or not this is true.

Other than the Framingham study, there hasn't been a great deal of research on the effect of high cholesterol in young people. Such studies require decades of tracking, which is both difficult to do and expensive.

Navar-Boggan, a Resident at Duke University Medical Center, also offers some practical advice: “It's never too soon for young adults to talk with their doctors about a comprehensive strategy for heart health, first and foremost focusing on diet and exercise. Our study suggests, though, that young adults who cannot control cholesterol with diet and exercise alone may benefit from medication earlier in life.”

An article on the study appears in Circulation.

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