Moderately elevated cholesterol in the healthy young bumps CVD mortality

  • Circulation

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Young healthy adults with mild-moderate cholesterol elevations have increased mortality risk, even if their 10-year atherosclerotic cardiovascular disease (CVD) risk is

Why this matters

  • These findings of increased CVD and coronary heart disease mortality even in young healthy people with higher values suggest consideration of earlier control.
  • An accompanying editorial says that the findings indicate “no threshold” for CVD risk increases with dyslipidemia but that treating those who fall into the risk range in this study would greatly increase the treatment population.

Key results

  • Vs low-density lipoprotein cholesterol
    • 100-129 mg/dL: 1.4 (1.1-1.7);
    • 130-159 mg/dL: 1.3 (1.1-1.6);
    • 160-189.9 mg/dL: 1.9 (1.5-2.4); and 
    • ≥190 mg/dL: 1.7 (1.3-2.3).
  • Adjusted HRs for CVD mortality vs
  • 160-189 mg/dL: 1.7 (1.4-2.2); and
  • ≥190 mg/dL: 1.5 (1.2-2.1).
  • Vs non-high-density lipoprotein values
    • 160-189 mg/dL: 1.3 (1.1-1.6);
    • 190-219 mg/dL: 1.8 (1.4-2.2); and
    • ≥220 mg/dL: 1.5 (1.2-2.0).
  • Risks remained significant even with an analysis focused on those with  
  • Study design

    • Observational study; 36,375 healthy participants (72% men; median age, 42 years) in the Cooper Center Longitudinal Study.
    • Followed median 26.8 years. 
    • Outcomes: associations of fasting cholesterol values with CVD mortality.
    • Funding: Internally funded.

    Limitations

    • Lipid-related therapies not recorded.
    • Mostly white study population.
    • No evidence to suggest lipid-lowering would improve outcomes.

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