Hyperlipidemia in early adulthood increases long-term risk of coronary heart disease.

Pubmed ID: 25623155

Pubmed Central ID: PMC4370230

Journal: Circulation

Publication Date: Feb. 3, 2015

Affiliation: From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.M.N.-B., E.D.P., B.N., M.J.P.); Boston University, Boston, MA (R.B.D.); and Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, Canada (A.D.S.).

MeSH Terms: Humans, Male, Adult, Female, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Risk Factors, Cohort Studies, Middle Aged, Coronary Disease, Prospective Studies, Follow-Up Studies, Time Factors, Hyperlipidemias

Grants: N01 HC025195, N01-HC-25195, N01HC25195, U19HS021092, U19 HS021092

Authors: Pencina MJ, D'Agostino RB, Peterson ED, Sniderman AD, Navar-Boggan AM, Neely B

Cite As: Navar-Boggan AM, Peterson ED, D'Agostino RB Sr, Neely B, Sniderman AD, Pencina MJ. Hyperlipidemia in early adulthood increases long-term risk of coronary heart disease. Circulation 2015 Feb 3;131(5):451-8. Epub 2015 Jan 26.



BACKGROUND: Many young adults with moderate hyperlipidemia do not meet statin treatment criteria under the new American Heart Association/American College of Cardiology cholesterol guidelines because they focus on 10-year cardiovascular risk. We evaluated the association between years of exposure to hypercholesterolemia in early adulthood and future coronary heart disease (CHD) risk. METHODS AND RESULTS: We examined Framingham Offspring Cohort data to identify adults without incident cardiovascular disease to 55 years of age (n=1478), and explored the association between duration of moderate hyperlipidemia (non-high-density lipoprotein cholesterol ≥ 160 mg/dL) in early adulthood and subsequent CHD. At median 15-year follow-up, CHD rates were significantly elevated among adults with prolonged hyperlipidemia exposure by 55 years of age: 4.4% for those with no exposure, 8.1% for those with 1 to 10 years of exposure, and 16.5% for those with 11 to 20 years of exposure (P<0.001); this association persisted after adjustment for other cardiac risk factors including non-high-density lipoprotein cholesterol at 55 years of age (hazard ratio, 1.39; 95% confidence interval, 1.05-1.85 per decade of hyperlipidemia). Overall, 85% of young adults with prolonged hyperlipidemia would not have been recommended for statin therapy at 40 years of age under current national guidelines. However, among those not considered statin therapy candidates at 55 years of age, there remained a significant association between cumulative exposure to hyperlipidemia in young adulthood and subsequent CHD risk (adjusted hazard ratio, 1.67; 95% confidence interval, 1.06-2.64). CONCLUSIONS: Cumulative exposure to hyperlipidemia in young adulthood increases the subsequent risk of CHD in a dose-dependent fashion. Adults with prolonged exposure to even moderate elevations in non-high-density lipoprotein cholesterol have elevated risk for future CHD and may benefit from more aggressive primary prevention.