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BP and Cholesterol in Young Adults and Later CV Events
Study Questions:
Is there an independent association between young adult exposures to risk factors and later life cardiovascular disease (CVD) risk, after accounting for later life exposures?
Methods:
The authors pooled data from six US cohorts with observations spanning the life course from young adulthood to later life, and imputed risk factor trajectories for low- (LDL-C) and high-density lipoprotein cholesterol (HDL-C), and systolic (SBP) and diastolic blood pressure (DBP) starting from age 18 years for every participant. Time-weighted average exposures to each risk factor during young (age 18-39 years) and later adulthood (age ≥40 years) were calculated and linked to subsequent risks of coronary heart disease (CHD), heart failure (HF), or stroke.
Results:
A total of 36,030 participants were included. During a median follow-up of 17 years, there were 4,570 CHD, 5,119 HF, and 2,862 stroke events. When young and later adult risk factors were considered jointly in the model, young adult LDL-C ≥100 mg/dl (compared with <100 mg/dl) was associated with a 64% increased risk for CHD, independent of later adult exposures. Similarly, young adult SBP ≥130 mm Hg (compared with <120 mm Hg) was associated with a 37% increased risk for HF, and young adult DBP ≥80 mm Hg (compared with <80 mm Hg) was associated with a 21% increased risk.
Conclusions:
Cumulative young adult exposures to elevated SBP, DBP, and LDL-C were associated with increased CVD risks in later life, independent of later adult exposures.
Perspective:
It is well known that life-long exposure to an elevated LDL-C in heterozygous familial hypercholesterolemia is associated with a marked increase in CV events at every level of LDL-C in adults. And young adults with a moderately elevated LDL-C have an increased risk of coronary artery calcification and coronary events in middle age. This is similar to findings with early adulthood hypertension and prehypertension. The unique contribution of this very large cohort study is that only mildly increased LDL-C is associated with a marked increase in CHD, and what historically is a mild elevation of SBP and DBP in young adults is associated with increase in HF independent of BP in middle age and older. Among the implications include that resources spent on lifestyle interventions in childhood and young adults, particularly in those with a family history of hypertension, elevated cholesterol, prediabetes, and obesity, may reduce the burden of atherosclerotic CVD. The findings are limited to significant increases in relative risk and should not be the sole reason for beginning pharmacologic therapy in early adulthood.
Keywords: Blood Pressure, Cholesterol, Cholesterol, LDL, Cholesterol, HDL, Coronary Disease, Heart Failure, Hypercholesterolemia, Hypertension, Life Style, Metabolic Syndrome, Middle Aged, Primary Prevention, Risk Factors, Stroke, Vascular Diseases, Young Adult
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