High blood pressure, cholesterol may increase health risks later in life
Elevated blood pressure and cholesterol levels in young adulthood may lead to an increased risk of heart disease later in life, regardless of later in life exposure to these risk factors, according to new research published in the Journal of the American College of Cardiology.
Using data from six large, community-based, prospective cohort studies, researchers modeled complete risk factor trajectories starting at age 18 through follow-up and used those trajectories to estimate the independent associations of risk factor exposures during young adulthood (age 18-39 years) and later adulthood (age 40 years and older) with subsequent risk of coronary heart disease, heart failure, and stroke. The researchers calculated period-specific time-weighted averages of systolic blood pressure (SBP), diastolic blood pressure (DBP), and high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol exposure levels for younger and older adults.
A total of 36,030 participants were included in the analysis. Over a follow-up period of 17 years, there were 4,570 incident coronary heart disease (CHD) events, 5,119 heart failure events, and 2,862 stroke events. Average measurements of SBP, DBP, LDL, and HDL from young adulthood were all strongly correlated with later in life averages, according to the study abstract.
Elevated LDL during young adulthood was associated with a 64 percent increased risk of coronary heart disease, independent of later life exposures. High SBP and DBP in young adulthood were independently associated with a 37 percent and 21 percent increased risk of heart failure, respectively. While no young adult exposures were independently associated with stroke, increased levels of high later life SBP or DBP were strong predictors of stroke, according to Andrew Moran, MD, MPH, senior author of the study and professor at Columbia University in in New York.
“Young adults are difficult to reach by way of traditional, clinic-based preventive programs,” Moran said in a statement. “They are transitioning between pediatric and adult-centered models of care, and often lack health insurance or experience frequent gaps in insurance coverage. Young adult utilization of ambulatory medical care and adherence to preventive health guidelines are the lowest of any age group.”
The researchers recommend implementation of preventive programs targeting individual young adults that are web-based, patient-centered, mobile, and account for the fact that this age group may discount the importance of their future heart disease risk.
A limitation of this study is that it relied on imputed risk factor levels before age 40 years. Future studies are needed to validate these findings in cohorts with a follow-up spanning from young adulthood to later in life.
"Our results add to accumulating evidence that young adulthood is a critical period when high blood pressure or cholesterol are particularly harmful,” said Moran. “Maintaining optimal levels of blood pressure and LDL cholesterol throughout young adulthood could yield substantial lifetime cardiovascular disease prevention benefits.”