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How Lifelong Cholesterol Levels Can Harm or Help Your Heart

LDL, or “bad” cholesterol, is a major risk factor for coronary heart disease. Now a new study suggests that, like smoking, it has a cumulative effect over a lifetime: The longer a person has high LDL, the greater their risk of suffering a heart attack or cardiac arrest.

Coronary heart disease, also known as “hardening of the arteries,” is the leading cause of death in the United States. It is caused by a buildup of plaque in the arteries that narrows the vessels and blocks the flow of oxygenated blood to the heart. Often, people have no symptoms and remain unaware they have the disease for years until they develop chest pain or suffer a catastrophic event like a heart attack.

Using data from four large prospective health studies, researchers calculated LDL levels over time in 18,288 people who had multiple LDL tests taken at different ages. They calculated their cumulative exposure to LDL and followed their health for an average of 16 years. The study is in JAMA Cardiology.

The researchers found that the longer a person had high levels of LDL — no matter what their LDL level is in young adulthood or middle age — the greater the risk for coronary heart disease. Compared with those in the lowest quarter for cumulative exposure, those in the highest had a 57 percent increased risk.

They found no increased risk for stroke or heart failure associated with cumulative LDL exposure. The researchers suggest that many factors can contribute to heart failure, and their study had too few cases of stroke to achieve statistical significance.

The study controlled for race and ethnicity, sex, year of birth, body mass index, smoking, high-density lipoprotein (HDL, or “good” cholesterol), blood pressure, Type 2 diabetes and the use of lipid-lowering and blood pressure medicines.

In people under 40, current guidelines recommend treatment with cholesterol-lowering statin drugs only with LDL readings higher than 190, but the researchers found that the increased risk for coronary heart disease may start at a much lower level. (LDL levels below 100 are generally considered normal.)

“Our figures suggest that the risk starts at LDL levels as low as 100,” said the lead author, YiYi Zhang, an assistant professor of medical sciences at Columbia. “That doesn’t necessarily mean that a person under 40 with an LDL of 100 should immediately start treatment. We need more evidence to determine the optimal combination of age and LDL level.”

Dr. Tamara Horwich, a cardiologist and professor of medicine at the University of California, Los Angeles, who was not involved in the study, noted that medical guidelines on choosing who needs statin therapy are heavily weighted toward older people, since advancing age is a major risk factor for complications from heart disease.

Still, she said, “From autopsy studies, we have known for some time that atherosclerosis begins to develop in the arteries of young individuals, as early as the teens and 20s. I think this study may entice physicians to move the needle back on the age of starting, or at least thinking about starting, statin therapy.”

Young people have a low short-term risk, Dr. Zhang said, but a high long-term risk. “The main message is to try to maintain low LDL through middle age. That will reduce your heart disease risk.”

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This study showcases how important it is to get your cholesterol checked, even from a very young age.  We know this to be the case at CCC-Mount Sinai all too well.  Just ask Dr. Rick Pumill to discuss his son Christopher's journey.  He's been prescribing him Statin since age 19 and he still has high LDL, despite regular exercise and a very good diet.  Moreover, Christopher Pumill is a cardiologist too, so he knows all too well about the risks and benefits of a sustaining a good level of LDL. 

We asked Dr. Christopher Pumill to add his perspective to this article:

"In all truthfulness, if you are obese, your cholesterol will change dramatically with diet and weightloss. However, if your cholesterol is elevated at a young age, it is very likely genetic. And therefore modification of diet will have a much smaller impact. For patients who are younger with high cholesterol, we often need medications (as in my case) and consideration of genetic testing and consultation, as it can be hereditary." 

His dad, Dr. Rick Pumill adds:

"I truly believe, having a personal connection with patients improves compliance and I also believe that making them understand that there are times that their abnormal studies are not their fault, makes a difference as well."

At CCC-Mount Sinai, your health and family are important to us.  Call us today at 201-499-7361 or go to our website to schedule an appointment for a cholesterol check on you or your children.  We can evaluate the whole family and help to treat (if necessary).

Authored by Maria Hergueta and published 10/18/21 on the NYtimes.com.

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