NEW YORK: It’s long been established that high levels of low-density lipoprotein cholesterol (LDL-C) — colloquially known as “bad” cholesterol — can lead to serious cardiovascular problems in older individuals.
But a new study suggests that young people with elevated LDL-C levels, even if they’re otherwise healthy, should take notice.
That’s because what may seem like a minor health issue when you’re young can lead to big problems later in life.
The observational study was published earlier this month in the medical journal Circulation.
The study set out to determine whether or not people considered to be at low risk for developing cardiovascular disease and coronary heart disease could see some benefit from lowering their cholesterol levels before they lead to complications.
The health progression of more than 36,000 participants, aged 42 on average, was examined over a period of 27 years.
Participants who were considered low risk for cardiovascular issues but had high LDL-C levels had a 30- to 40-percent greater chance of dying prematurely due to heart health problems.
The lead study author told Healthline that the findings underline the importance of lifestyle changes, while a cardiologist interviewed by Healthline said it’s a teachable moment for patients and physicians alike.
Dr. Shuaib Abdullah, a lead study author and assistant professor at the University of Texas Southwestern Medical Center, told Healthline that researchers were looking for answers to the question of when to start statin therapy for low-risk patients with high LDL-C levels.
“I would frequently come across relatively healthy patients in their 40s and 50s with elevated LDL-C levels, but few or no other risk factors. When discussing their risk for cardiovascular outcomes with them, I felt that data on cardiovascular prognosis were limited in low-risk individuals with LDL-C, with even less data for those patients with LDL-L with more moderately elevated levels,” he wrote in an email to Healthline.
“There was no clear consensus on what LDL-C level to start statin therapy at, or whether to treat LDL-C at all in low-10-year-risk individuals,” he added.
While Abdullah says the findings were not especially surprising, they provide valuable insights into the risk factors that can lead to cardiovascular issues later in life.
Dr. Andrew Freeman, the director of Cardiovascular Prevention and Wellness, as well as Clinical Cardiology and Operations at National Jewish Health, agrees.
“In a lot of ways, LDL cholesterol has been likened to cigarettes, where one cigarette probably won’t hurt you, but the packs that accumulate will,” Freeman told Healthline. “With this, it’s the same thing: When you’re exposed to higher LDL levels for longer periods of time, it seems to be associated with higher cardiovascular risk.”
Abdullah says the research helps explain why older people who were previously thought to be healthy are sometimes found to have serious cardiovascular issues.
“Not too infrequently, we do see patients in their 50s, 60s, or early 70s admitted with a myocardial infarction or other condition related to advanced coronary artery disease, who previously appeared to be healthy, but had moderately elevated cholesterol levels in their records,” he wrote.
He points out that another important finding was that other cholesterol sub-fractions — in other words, cholesterol that isn’t LDL-C or high-density lipoprotein (HDL-C) — were also associated with increased cardiovascular risk.
When it comes to lowering risk factors for heart disease, it comes down to the same old advice: Exercise and eat right.
Ultimately, the patients themselves are the only ones who can make these changes. But Freeman says it’s important for physicians to properly educate their patients.
“This is a great opportunity for physicians to spend time counseling patients about lifestyle,” he said. “The only problem is that lifestyle is not very well trained during medical school.”
He points to a 2017 study that he co-authored, where it was found that the vast majority of cardiologists polled had next-to-no training on nutrition.
“It’s pretty scary — like, 90 percent of us have zero or minimal training,” he emphasized. “I think this is another underscore, that we, as physicians, need to get better at applying lifestyle medicine, use it as a tool in our arsenal, and counsel our patients appropriately. I would argue that it’s pretty much not done in the vast majority of cases, to any extensive level, where a patient walks away and changes their behavior. I think we can do a lot better.”
Freeman says this points to a line in the Hippocratic oath that compels physicians to do their best to prevent disease before it manifests.
Indeed, the effects of diet intervention can yield dramatic results when it comes to reducing LDL-C levels.
“A lot of people underestimate the power of diet in reducing cholesterol,” said Freeman. “As an example, by increasing soy protein, decreasing saturated fat, boosting exercise and losing just a few pounds, it’s possible to get significant cholesterol reduction — I’m talking 40 to 50 percent, believe it or not, just with lifestyle alone. I think, before we commit our young population to large amounts of medication, we really should use these tools because they really are effective.”