Especially in the Young, Cholesterol Is No Friend to the Heart

Especially in the Young, Cholesterol Is No Friend to the Heart

Rising levels of cholesterol among young adults is strongly tied to long-term odds for the number one killer, heart disease, a new study finds.

The new global study involved data on more than 400,000 people from 38 different trials. Their health was tracked for an average of more than 13 years, but some were followed for up to 43 years.

The researchers looked especially at the effect of blood levels of all forms of cholesterol except "good" HDL cholesterol.

Reporting Dec. 3 in The Lancet, the investigators found that, regardless of age, higher levels of this "non-HDL" cholesterol were tied to raised odds for heart disease, as well as fatalities due to heart disease.

The effect was especially pronounced in people who were young when their cholesterol levels began to rise - probably because their cardiovascular systems were then taxed by cholesterol for many years to come.

For example, among men younger than 45, the risk of having fatal or nonfatal heart disease or stroke by the age of 75 was just 12% for those with low non-HDL cholesterol. But the risk rose to 43% for those with high levels, the study found.

Among women younger than 45, those percentages were 6% and 24%, respectively.

However, healthy lifestyle changes - such as better diets and exercise - could greatly lower cholesterol levels and a person's lifetime risk of heart trouble, the study authors said.

For example, among adults younger than 45 with at least two heart disease risk factors, cutting non-HDL cholesterol levels in half cut their odds of later-life heart illness from about 16% to 4% among women, and from about 29% to 6% among men, the study found.

"This reduction in risk is larger the sooner cholesterol levels are reduced," study co-author Stefan Blankenberg, of the German Center for Cardiovascular Research, in Germany, added in a journal news release.

Early and intensive action to reduce non-HDL cholesterol levels could reverse the initial narrowing of the arteries, but it's not clear whether slightly increased or normal cholesterol levels affect heart disease risk, or at which levels treatment should be recommended, particularly in younger adults, the study authors said.

Two U.S. heart experts unconnected to the study agreed that high levels of non-HDL cholesterol are problematic at any age.

For younger patients, "this study demonstrated that long-term exposure to high levels of non-HDL cholesterol with at least two other risk factors would cause an increased long-term risk of cardiovascular disease - even more than if this elevation occurred after age 45," noted Dr. Guy Mintz.

He directs cardiovascular health at Northwell Health's Sandra Atlas Bass Heart Hospital, in Manhasset, N.Y.

Using this data to help warn young patients of the dangers "can be very effective in motivating patients to change," Mintz believes.

So what should people in their 30s and 40s do if they find themselves with high levels of non-HDL cholesterol?

"Rather than the early use of medications, I feel that patients with this type of risk profile would benefit from focused lifestyle modification - including weight loss, regular exercise and improvement of their metabolic state, including pre-diabetes -- before committing to very long-term statin drug therapy," Mintz advised.

Dr. Eugenia Gianos directs women's heart health at Lenox Hill Hospital in New York City. Reading over the new study she said it "confirms the relationship between exposure to elevated cholesterol over time and risk of developing cardiovascular disease."

The data is also a "key reminder that we need to start cardiovascular prevention efforts early in life to avoid the downstream effects," Gianos said. "Whether you get there with lifestyle or medication, it is imperative to substantially reduce lipid levels to reduce risk."

Especially in the Young, Cholesterol Is No Friend to the Heart

Sources: Eugenia Gianos, M.D., director, women's heart health, Lenox Hill Hospital, New York City; Guy L. Mintz, M.D., director of cardiovascular health and lipidology, Northwell Health's Sandra Atlas Bass Heart Hospital, Manhasset, N.Y.; The Lancet, news release, Dec. 3, 2019.

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