Elevated lipid levels may be tied to cardiac damage in adolescents, young adults
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Key takeaways:
- Increased lipid levels from age 17 to 24 years were tied to worsening cardiac structure and function.
- Addressing elevated lipid levels early may improve outcomes and save costs in the long term.
Elevated lipid levels were associated with worsening structural and functional cardiac damage in adolescents and young adults, though in the case of LDL, the relationship was partially mediated by elevated BP and fat mass, data show.
“Evidence on the effect of increasing cholesterol levels on the heart of adolescents and young adults was lacking,” Andrew O. Agbaje, MD, MPH, physician and clinical epidemiologist with the Institute of Public Health and Clinical Nutrition at the University of Eastern Finland, told Healio. “Several studies have associated elevated cholesterol levels in adolescence with premature mortality, stroke and heart attacks in the mid-40s and 50s. This evidence informs the current guidelines on the current age for regular cholesterol checks, which is at age 40 years. Unfortunately, we now see that the damage to the heart in relation to increasing cholesterol levels might have begun 2 decades earlier, and therefore we miss a good chance to prevent adverse events. Checking cholesterol levels at age 40 years is too late and a tragic loss of preventive opportunity.”
Agbaje analyzed data from 1,595 adolescents aged 17 years at baseline (60% female) from the Avon Longitudinal Study of Parents and Children who had fasting plasma total cholesterol, triglycerides, HDL, LDL and non-HDL measured at age 17 and 24 years. The findings were published in Atherosclerosis.
The outcomes of interest were left ventricular hypertrophy, defined as LV mass indexed for height2.7 of 51 g/m2.7 or more, and LV dysfunction, defined as LV diastolic function from mitral E/A ratio less than 1.5.
Lipids, LV hypertrophy and LV dysfunction
Agbaje found that the prevalence of LV hypertrophy increased from 3.6% at age 17 years to 11.6% in males and from 1.6% at age 17 years to 4% at age 24 years in females, and that the prevalence of LV dysfunction increased from 7.8% at age 17 years to 16.6% in males and from 10.3% at age 17 years to 15.4% at age 24 years in females.
At 7 years, the following lipid parameters were associated with higher odds of worsening LV hypertrophy: total cholesterol (OR per 1 mmol increase = 1.18; 95% CI, 1.09-1.27), triglycerides (OR per 1 mmol increase = 2.89; 95% CI, 1.54-5.43), LDL (OR per 1 mmol increase = 1.19; 95% CI, 1.08-1.32) and non-HDL (OR per 1 mmol increase = 1.21; 95% CI, 1.11-1.33).
Triglycerides were associated with higher odds of worsening LV dysfunction at 7 years (OR per 1 mmol increase = 1.98; 95% CI, 1.06-3.71), Agbaje wrote.
There was no relationship between HDL levels and worsening cardiac structure and function.
The relationship between LDL and worsening LV hypertrophy was partially mediated by systolic BP (12%) and fat mass (25%), Agbaje found.
“The results are similar in both males and females, and it unfortunately affects adolescents with normal weight and normal blood pressure alike,” Agbaje told Healio. “A $60-per-person cholesterol check in adolescence may prevent $200,000 worth of medical intervention by age 50 years. It is rather sad that universal pediatric lipid screening is still an ongoing debate, while we lose several brilliant minds to the potential pangs of heart diseases and premature death. We have proposed an ‘adolescent cholesterol passport’ in the form of a vaccination card that enables teenagers to check and record their cholesterol level once every 10 years at the health center. This will save at least one in five cases of future heart diseases, and enable early detection and prevention.”
‘A devil’s triad’
The findings dovetail with a prior study showing that sedentary behavior in childhood contributes greatly to increases in cholesterol between mid-adolescence and young adulthood, Agbaje told Healio.
“These new studies present a devil’s triad of sedentariness-hypercholesterolemia-heart damage by mid-20s, leading to a pathologic vicious cycle that stops the heartbeat,” he said. “Nonetheless, there is good news, one of the solutions we have identified is that light physical activity of 3 to 4 hours per day from childhood significantly lowers cholesterol levels, and children, adolescents and young adults should be encouraged to accumulate this amount of light exercise every day.”
For more information:
Andrew O. Agbaje, MD, MPH, can be reached at andrew.agbaje@uef.fi.
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