High blood pressure, cholesterol before age 55 tied to elevated heart disease risk
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Key takeaways:
- Elevated BP and LDL before age 55 years may increase coronary heart disease risk.
- Data suggest cumulative risk factor control in early and middle adulthood brings additional CV benefits.
Researchers reported that exposure to elevated LDL and elevated systolic BP before age 55 years is associated with increased coronary heart disease risk independent of later-life BP and cholesterol levels.
“Currently, therapeutic strategies for cholesterol and BP lowering are based on short-term clinical trials,” Abbas Dehghan, MD, PhD, FESC, professor of molecular epidemiology and director of postgraduate research at Imperial College London, and colleagues wrote in PLOS ONE. “If longer exposure to high cholesterol and BP has a cumulative effect as reported by Mendelian randomization studies, this will have substantial implications for the management of coronary heart disease. There may be a role for earlier treatment in low-risk and younger patients if there are indeed additional benefits with cumulative risk factor control.”
Elevated BP and LDL before age 55 years may increase coronary heart disease risk.
Image: Adobe Stock
Dehghan and colleagues conducted a three-sample Mendelian randomization analysis using individual patient data from the UK Biobank (enrolled 2006-2010), including 136,648 participants for LDL measurements, 135,431 participants for systolic BP, and 24,052 cases for CHD (incident and prevalent) to assess the effect of duration of exposure to the risk factors on risk for CHD. Researchers stratified analyses by age at enrolment (< 55 years; 55 to 60 years; 61 to 65 years; and > 65 years). The primary outcome was CHD, defined as a composite of CV death, nonfatal MI or coronary revascularization.
Univariable Mendelian randomization analysis showed a significant association between genetically predicted LDL and risk for CHD across all four age groups, with no evidence of heterogeneity between groups (P for heterogeneity = .107).
“Each 1 mmol/L higher LDL was associated with 81% higher odds of CHD at age < 55 years, 52% higher odds at age 55 to 60 years, 106% higher odds at age 61 to 65 years and 60% higher odds at age 65 years,” the researchers wrote. “For each 10 mm Hg increase in genetically mediated systolic BP, the odds of CHD increased by 62% for individuals aged < 55 years, 46% for those aged 55 to 60 years, 30% for those aged 61 to 65 years and 17% for those aged 65 years.”
In multivariable Mendelian randomization analyses, exposure to elevated LDL and systolic BP before age 55 years was associated with a higher risk for CHD independent of later life levels (age 55 years and older), with an OR of 1.68 per 1 mmol/L for LDL (95% CI, 1.2-2.34) and an OR of 1.33 per 10 mm Hg of systolic BP (95% CI, 1.18-1.51).
“These findings highlight the critical role of cumulative exposure to these risk factors in an individual’s risk of CHD, indicating that past exposure to elevated systolic BP and LDL has long-lasting implications on future CHD risk,” the researchers wrote.
The researchers also noted that the findings suggest that old age alone “should not be a reason to withhold otherwise appropriate LDL and BP-lowering treatments, because the effect of genetically mediated LDL and systolic BP on the incident risk of CHD is consistent throughout life.”
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