Researchers identify lipid cutoffs for CVD risk in young adults without diabetes
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Researchers have identified lipid cutoffs that may indicate elevated risk for MI and stroke among young adults aged 20 to 39 years without a history of diabetes, according to findings published in European Journal of Preventive Cardiology.
Researchers reported that a total cholesterol level of 200 mg/dL or more and LDL level of 130 mg/dL or more were associated with elevated risk for CVD events within a large cohort of more than 6 million young adults in Korea.
“Considerable uncertainty exists about the extent to which slightly increased cholesterol levels affect long-term cardiovascular risk and about which cutoff should be used to merit a treatment recommendation in young people,” Mee Kyoung Kim, MD, PhD, of the division of endocrinology and metabolism, department of internal medicine at Yeouido St. Mary’s Hospital and The Catholic University of Korea College of Medicine in Seoul, South Korea, and colleagues wrote. “Our study extends the current knowledge because it suggests that even slightly increased concentrations of total cholesterol, LDL-C, non-HDL-C and triglycerides may predict long-term cardiovascular risk in young populations.”
For this prespecified analysis, researchers used data from the nationally representative Korean National Health Insurance System database to identify lipid cutoffs associated with increased risk for CVD among adults aged 20 to 39 years without diabetes.
The analysis consisted of 6,204,153 young adults who underwent health examinations from 2009 to 2012 and followed until the end of 2018. The primary outcome was incident CVD, defined as MI and stroke.
Reference cholesterol parameters were defined as follows: total cholesterol level less than 140 mg/dL, triglyceride level less than 60 mg/dL, LDL level less than 100 mg/dL and non-HDL level less than 130 mg/dL.
During a median follow-up of 7.7 years, Kim and colleagues found MI occurred in 0.23% of participants, stroke in 0.15% and the composite of incident CVD in 0.38%.
Researchers observed significantly elevated risk for CVD events in participants with the following cutoffs compared with the reference cholesterol parameters:
- total cholesterol level of 200 mg/dL or more;
- triglyceride level of 60 mg/dL or more;
- LDL level of 130 mg/dL or more; or
- non-HDL level of 140 mg/dL or more.
Total cholesterol cutoffs significant for increased risk for CVD were 240 mg/dL for people with no other risk factors; 220 mg/dL for people with one risk factor; and 200 mg/dL in people with two to three risk factors.
Moreover, participants with higher total cholesterol were more often older, male and obese; were more likely to be current smokers and heavy alcohol drinkers; and were more likely to have hypertension.
“At present, calculated risk is one of the primary criteria adopted by guidelines to initiate lipid-lowering therapy to reduce the subsequent risk of CVD,” the researchers wrote. “Because age is the principal determinant used in risk engines or guideline algorithms, lipid-lowering interventions become common only after 60 years of age except for those with markedly elevated LDL-C levels or diabetes. Although the 10-year risk is low in young and middle-aged adults who are not treated according to current guidelines, they ultimately account for most incident ASCVD cases.”
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