Elevated non–HDL-C in young adulthood remains high over life course
A study has revealed that most adults who have elevated nonhigh-density lipoprotein cholesterol (non–HDL-C) early in life will continue to have high non–HDL-C for the rest of their lives, which can significantly increase their risk of cardiovascular disease (CVD).
The authors included a total of 2,516 participants (aged 25–40 years) free of CVD and diabetes from the Framingham Offspring study who had their non–HDL-C progression modeled over eight study examinations (mean follow-up, 32.6 years) using group-based methods.
Kaplan-Meier analyses were performed for those with mean non–HDL-C ≥160 mg/dl (high) and <130 mg/dl (low) at the first two examinations to assess CVD risk based on 25–30 years of follow-up. The authors adjusted the levels of non–HDL-C for participants on lipid treatment using nonparametric algorithm.
Lipid levels among participants showed largely stable trajectories over their 30-year life course. Mean non–HDL-C measured in young adulthood were strongly associated with non–HDL-C levels later in life. Thus, individuals could be delegated to either high or low non–HDL-C groups based on two measurements collected between 25–40 years of age.
On subsequent testing at 25 years, majority (80 percent) of individuals with non–HDL-C ≥160 mg/dl at the first two exams remained in the high group, while a greater proportion (88 percent) of those with non–HDL-C <130 mg/dl remained below 160 mg/dl. Additionally, individuals with high non–HDL-C in young adulthood showed a higher CVD risk in the next 25 years as compared with those with low non–HDL-C (22.6 vs 6.4 percent).
“The results demonstrate that early lipid monitoring before 40 years of age would identify a majority of those with a high likelihood for lifetime elevated lipid levels who also have a high long-term risk for CVD,” the authors said. “This information could facilitate informed patient–provider discussion about the potential benefits of preventive lipid-lowering efforts during the early midlife period.”