By Andrew M. Seaman
(Reuters Health) – 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.
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).
“What we found is that people with prolonged exposure to high cholesterol levels are at a much higher risk of cardiovascular events than people without that exposure,” said Michael Pencina, the study’s senior author from Duke University in Durham, North Carolina.
“Many of these people would not be candidates for treatment using the new guidelines,” he said. “They 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 medications, known as statins (see Reuters story of November 12, 2013 here: reut.rs/1yZKdUC.)
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.
“What was most interesting and slightly unexpected is that the expansion is almost entirely in the age group 60 and above,” Pencina 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, the researchers reported in the journal Circulation.
“We know from biology that cholesterol accumulates in the arteries over time,” Pencina said. “So the more we wait the more accumulation you have.”
Dr. Steven Nissen, who was not involved with the new study, said the new article illustrates the concerns many cardiologists have with the new guidelines. Specifically, he said the guidelines have a cut off for statin use at age 40.
“If you really think about it, the people you want to treat are people who have long-term risk early enough in life to make a difference,” said Nissen, chairman of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at Cleveland Clinic in Ohio.
“To say don’t treat anyone younger than 40 is not sensible,” he said. “This article suggests it really isn’t sensible,” adding that it’s especially true for people with genetic conditions that increase cholesterol even earlier in life.
Pencina said he and his colleagues 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.
Pencina says younger people should 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: bit.ly/1JYYqTh Circulation, online January 26, 2015.