High Cholesterol in Young Adults Predicts Atherosclerosis Later in Life

A study conducted by researchers from University of California — San Francisco (UCSF) Medical Center has found that young adults “with even modestly elevated cholesterol levels are more likely to develop coronary artery calcium and atherosclerosis later in life.” In fact, the researchers reported that “cholesterol levels found in the majority of young adults in their 20s and 30s are associated with damage to coronary arteries, which can accumulate over time and persist into middle age.”

In a news release from UCSF Medical Center, lead author Mark J. Pletcher, MD, MPH, associate professor of epidemiology and biostatistics and of medicine at UCSF, said that, contrary to current thinking that higher-than-normal levels of cholesterol and lipid exposure in teens and young adults doesn’t warrant much concern, these findings show that “young adulthood is an important time [to monitor cholesterol levels] because lasting damage already starts to accumulate at this age.” Pletcher also said that there should be more emphasis on lifestyle interventions in young adults with “nonoptimal” cholesterol levels and that “in order to prevent heart disease and stroke more effectively, we should be thinking about cholesterol at a younger age.”

For the study, results of which were published in the August 3, 2010, issue of the Annals of Internal Medicine, researchers measured Low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, triglycerides, and coronary calcium in more than 3200 participants age 18-30 from the CARDIA (Coronary Artery Risk Development in Young Adults) study.

They estimated “time-averaged cumulative exposures to lipids between age 20 and 35 years” based on subjects’ serum lipid measurement scores from the CARDIA study. Researchers then compared these metrics to coronary calcium scores assessed 20 years later. More than 85% had “nonoptimal levels” of LDL cholesterol, HDL cholesterol, or triglycerides during young adulthood. Subjects who maintained optimal LDL levels had a lower prevalence (8%) of coronary calcium compared to those (44%) who had LDL levels of 160 mg/dL or higher.

The news release reported that the study revealed that “even modest rises in LDL — as low as 100-129 mg/dL — were associated with a significantly higher risk of atherosclerosis.” Sixty-five percent of the young adults in the study had LDL levels greater than 100 mg/dL.

The study authors wrote that “Both LDL and HDL cholesterol levels were independently associated with coronary calcium after participants who were receiving lipid-lowering medications or had clinically abnormal lipid levels were excluded.” Based on analysis of these data, the authors concluded that “Nonoptimal levels of LDL and HDL cholesterol during young adulthood are independently associated with coronary atherosclerosis 2 decades later.”

Senior study author Stephen B. Hulley, MD, MPH, professor in the division of clinical epidemiology at UCSF, said that this study “shows that cholesterol levels in young adults are more important than we previously believed, because even the moderate non-optimal levels that are present in most young adults may alter their health decades later.” Hopefully, this information will convince young adults that “it probably matters in the long run what they eat and how much they exercise, even though their risk for having a heart attack in the short term is low.”