People with even moderately high cholesterol levels in their 30s and 40s are more likely to have heart disease later in life, according to a new study from Duke University in Durham, North Carolina.
But many of them wouldn't meet the criteria for treatment under guidelines from the American Heart Association and the American College of Cardiology (AHA/ACC).
The researchers found that people with prolonged exposure to high cholesterol levels are at a much higher risk of cardiovascular events than people who do not have elevated cholesterol. Yet many of these people would not be candidates for treatment using the new guidelines from the American Heart Association and the American College of Cardiology (AHA/ACC) and, as a result, may fall through the cracks.
In 2013, the AHA and ACC issued new guidelines that said exercise and a healthy diet are the most important steps for preventing high cholesterol. Additionally, the guidelines expanded the group of people eligible for cholesterol-lowering statin medications.
The guidelines say statins could be beneficial for people with known heart disease; those with a "bad" LDL cholesterol level of 190 or higher; patients with type 2 diabetes between the ages of 40 and 75; and individuals ages 40 to 75 with at least a 7.5 percent risk of developing heart disease over the next 10 years, based on new risk assessment formulas.
In Canada, guidelines recommend physicians begin screening cholesterol in men at age 40 and in women at age 50 or earlier in people with certain risk factors or health conditions.
Canadian guidelines also state statins should be considered for people with a LDL cholesterol of 5 mmol/L or higher whose risk of risk of developing heart disease over the next 10 years is less than 10 percent (considered low risk), in people with a LDL of 3.5 mmol/L or higher whose risk of developing heart disease over the next 10 years is 10 to 19 percent (intermediate risk), and in people who are deemed high risk for developing heart disease.
“What was most interesting and slightly unexpected is that the expansion is almost entirely in the age group 60 and above,” the lead researcher said. “That left us with the question, what about younger people?”
Using data from 1,478 adults without heart disease at age 55, the researchers found that heart disease eventually developed in about 4 percent of those who always had good cholesterol levels, 8 percent of those who'd had high cholesterol for one to 10 years and 17 percent of those with high cholesterol for 11 to 20 years.
But only one in six of the people with high cholesterol would have met the recommendations for statin use at age 40. That increased to one in three people by age 50.
Cholesterol accumulates in the arteries over time; the longer you wait to treat it the more accumulation occurs.
Experts not involved with the study say the new report illustrates the concerns many cardiologists have with the new guidelines. Specifically, the guidelines have a cut off for statin use at age 40. They contend the people you want to treat are people who have long-term risk early enough in life to make a difference.
The researchers of the new study stopped short of suggesting wider statin use among younger people, because there needs to be long-term studies on its safety. Statins are not free of risks; rarely, they can cause liver or muscle problems, high blood sugar, or memory issues.
They advise younger people to get their cholesterol checked and establish a baseline. “You don’t have to attack it with statins – maybe you do after you’ve tried other things,” he added. “Statins should be the last resort. First see how much you can do with lifestyle interventions like diet and exercise.”
Source: Circulation, online January 26, 2015.
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