Abnormal Cholesterol in Young Adults Predicts Later Heart Disease

Kathleen Blanchard's picture

Even modestly abnormal cholesterol levels in young adulthood can predict future heart disease. Researchers say young adults in their 20's and 30's with even mildly abnormal levels of good (HDL) or bad (LDL) cholesterol experience damage to the coronary arteries that can later lead to heart disease.

The findings are from the Coronary Artery Risk Development in Young Adults study (CARDIA) that enlisted 47 percent African American and 56 percent female participants who were followed for two decades. Findings show that cholesterol levels early in life may need more focus.

Abnormal Cholesterol Levels In Young Adults Leads to Atherosclerosis by Age 45

Mark J. Pletcher, MD, MPH, who is first author on the study, says the findings are contrary to the belief that abnormal cholesterol levels pose no problem for young adults. He suggests lifestyle interventions that keep cholesterol levels in check even in young adulthood is important to heart disease prevention. The study showed that even modest rises in LDL cholesterol produced atherosclerosis by age 45.


Pletcher, who is an associate professor of Epidemiology & Biostatistics and Medicine at University of California, San Francisco says, "We don't usually worry too much about heart disease risk until a person is in middle age because it's rare to have a heart attack in young adulthood. However, our evidence shows that young adulthood is an important time because lasting damage already starts to accumulate at this age. In order to prevent heart disease and stroke more effectively, we should be thinking about cholesterol at a younger age."

The study followed young adults for 20 years who were between age 18 and 30 and included 3,258 healthy men and women. Cholesterol levels that were even modestly abnormal were found to lead to plaque buildup from atherosclerosis by age 45.

Cholesterol, including good HDL and bad LDL levels were measured as well as triglycerides at regular intervals. Calcium artery scoring was performed with CT scan at age 45. Forty four percent of young adults studied whose LDL level was greater than 160 mg/dL had calcifications from atherosclerosis twenty years later, compared to eight percent of those whose LDL level was less than 70 mg/dL and considered optimal.

Stephen B. Hulley MD, MPH, senior author of the report says, "The 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. For many people in their 20s and 30s, 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."

Most of the young adults studied had LDL cholesterol levels higher than 100 mg/dL. Whether statins should be used remains the subject of debate. Current cholesterol guidelines from the American Heart Association suggest treating young adults with statins only when cholesterol levels are extremely high and after lifestyle modification including diet and exercise fail. The findings show that cholesterol levels in young adulthood can predict future heart disease.