Cholesterol levels predict if under-45s will ever have heart disease

A person’s cholesterol levels before the age of 45 can predict their lifetime risk of developing cardiovascular disease. The finding has prompted debate about whether younger people should be recommended preventative measures, such as taking statins.

The result comes from an analysis of medical data on nearly 400,000 people of European ancestry from across Europe, Australia and North America. The study found that when blood concentrations of non-HDL cholesterol – often known as “bad cholesterol” – are higher than 145 milligrams per 100 millilitres before the age 45, a person’s relative risk of developing heart disease at some point in their life nearly doubles.

For concentrations between 100 and 145 milligrams before 45, the relative lifetime risk increases by 10 to 20 per cent.

“It is important because people might want to know how they could lower their risk,” says Frank Kee at Queen’s University Belfast, UK, who worked on the study.

We have known since the 1980s that cholesterol is linked to atherosclerosis – the clogging of arteries that can cause cardiovascular disease, which includes heart disease and stroke. There are many ways a person can lower their lifetime risk of this, such as lifestyle changes and taking medications. For example, in the past 30 years, statin drugs have been widely prescribed to lower cholesterol, contributing to small life expectancy gains.

Under existing guidelines, people in the UK and US are only prescribed statins based on their estimated 10-year risk of developing cardiovascular disease, not their lifetime risk, says Kee.

The study provides compelling data that lowering cholesterol earlier on in life could be highly beneficial, says Betty Raman at the University of Oxford.

However, statins can have painful side effects, and some researchers, including the Danish doctor Uffe Ravnskov, argue that there is no link between cholesterol levels and heart disease – although this is disputed by many. Ravnskov suggests that the link between cholesterol and cardiovascular risk in this study might be explained by stress, which younger adults are more likely to experience.

But Tom Marshall at the University of Birmingham, UK, says the findings add to a body of work showing that the link between cholesterol and heart disease is stronger at younger ages. “This means that the relative benefits of treatment may be larger in younger people,” he says.

However, Marshall says there isn’t enough evidence yet to change statin guidelines. That is because it isn’t clear how much extra benefit someone would get from taking high-dose statins 10 or 20 years earlier, he says.