Maintaining optimal lipid levels throughout life is a necessary component of ideal cardiovascular health and has the potential to dramatically reduce the lifetime risk of developing atherosclerotic cardiovascular disease, according to a review published Aug. 27 in the Journal of the American College of Cardiology. 

Brian A. Ference, MD, MPhil, MSC, FACC, et al., discuss the effects of lipid-carrying lipoproteins on the risk of cardiovascular disease, the importance of maintaining optimal lipid levels and how to help people achieve lipid levels necessary for ideal cardiovascular health.

The authors write that the goal of maintaining optimal lipid levels throughout life is to keep the concentration of circulating LDL and other apo B–containing lipoproteins low to minimize the number of particles that become retained in the arterial wall and thereby minimize the rate of progression of atherosclerotic plaques as a strategy to reduce the risk of developing a cardiovascular event. The two strategies to achieve this are primordial prevention, or preventing the development of risk factors, and primary prevention, or lowering lipid levels to achieve more optimal levels as a strategy to prevent cardiovascular events among people who do not have existing clinical evidence of cardiovascular disease.

They explain that the effectiveness of lipid-lowering strategies will depend on the timing of implementation. Those who have been exposed to increased lipid rates for many years will still experience residual risk after beginning lipid-lowering therapies. It is important to recognize that atherosclerosis is a chronic progressive disease that begins early in life and slowly progresses over several decades before becoming clinically manifest.

Having heart healthy behaviors, particularly healthy diet, is the best way to achieve and maintain optimal lipid levels throughout adulthood without the risk of medication-induced side effects, according to the authors. For many people, however, diet and other lifestyle changes may not be enough to maintain optimal lipid levels throughout life. In these patients, lipid-lowering therapy, such as a low-dose statin or ezetimibe, may be prescribed.

The authors note that there are barriers to achieving optimal lipid levels in a population. Policymakers, communities and schools, and cardiovascular professional societies and organizations all play important roles in preventing cardiovascular disease. Individuals must also be empowered to understand the importance of maintaining healthy lipid levels.

“Because apo B–containing lipoproteins have both causal and cumulative effects on the risk of atherosclerotic cardiovascular disease, the most effective strategy to prevent cardiovascular events by slowing the rate of atherosclerotic plaque progression would be to achieve optimal lipid levels as early in life as possible and maintain those optimal lipid levels throughout life,” the authors conclude.

This paper is the third in an eight-part cardiovascular health promotion JACC focus seminar, where each paper focuses on a different behavioral consideration that impacts cardiovascular health: nutrition and diet; tobacco-free lifestyle; healthy weight; exercise and physical activity; blood pressure; cholesterol; blood sugar; and psychological health.

Keywords: Hydroxymethylglutaryl-CoA Reductase Inhibitors, Apolipoproteins B, Risk Factors, Plaque, Atherosclerotic, Atherosclerosis, Primary Prevention, Apolipoprotein B-100

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