Hyperlipidemia in Early Adulthood Increases Long-Term Risk of Coronary Heart Disease | Journal Scan

Study Questions:

Is there an association between years of hypercholesterolemia in young adults and future coronary heart disease (CHD)?

Methods:

The Framingham Offspring Cohort data were used for the present analysis. Adults with no clinically evident cardiovascular disease and under the age of 55 years were included. Moderate hyperlipidemia was defined as a non–high-density lipoprotein (HDL) cholesterol ≥150 mg/dl. Duration of moderate hyperlipidemia was the exposure of interest. The primary outcome of interest was CHD, defined as the occurrence of one or more of the following: myocardial infarction, angina, coronary insufficiency, and/or CHD death.

Results:

A total of 1,478 young adults were included. Over a median follow-up of 15 years, 155 adults developed CHD. Adults with 11-20 years of hyperlipidemia at baseline had an overall CHD risk of 16.5% (95% confidence interval [CI], 13.5-19.9%) compared with 8.1% (95% CI, 5.5-11.7%) for adults with 1-10 years of hyperlipidemia, and 4.4% (2.9-6.6%) for those without hyperlipidemia at baseline. The unadjusted risk of CHD doubled for every 10 years of exposure to hyperlipidemia (hazard ratio [HR], 2.0; 95% CI, 1.63-2.45 per decade of hyperlipidemia). This association was attenuated, but remained statistically significant after adjusting for other CHD risk factors (adjusted HR, 1.49; 95% CI, 1.20-1.87 per decade of hyperlipidemia). The association remained statistically significant after also adjusting for non–HDL-C at baseline, and also remained significant after adjusting for lipid-lowering therapy use at baseline and follow-up.

Conclusions:

The authors concluded that cumulative exposure to hyperlipidemia in young adulthood increases subsequent risk of CHD in a dose-dependent fashion. Adults with prolonged exposure to even moderate elevations in non–HDL-C have elevated risk for future CHD, and may benefit from more aggressive primary prevention.

Perspective:

These findings are not surprising, given that atherosclerosis starts early in life. Prevention efforts, in particular lifestyle modification initiated early in life, are likely the key to reducing risk related to lipids. In addition, information on duration of lipids incorporated into risk prediction tools may be a future means for identifying individuals at increased risk over time.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Atherosclerotic Disease (CAD/PAD), Homozygous Familial Hypercholesterolemia, Lipid Metabolism, Nonstatins

Keywords: Atherosclerosis, Cholesterol, HDL, Coronary Disease, Coronary Artery Disease, Hypercholesterolemia, Hyperlipidemias, Primary Prevention, Risk Factors, Angina Pectoris, Myocardial Infarction


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