Earlier cholesterol checks could prevent up to 20-percent of premature heart disease

High cholesterol levels in adolescence can cause structural and functional cardiac damage leading to premature heart damage and death, but a new study finds earlier checks could prevent 20-percent of the adult population developing preventable heart problems.

Conducted in collaboration between the University of Exeter, University of Bristol, and the University of Eastern Finland, results are published in Atherosclerosis. The current study used data from the University of Bristol’s Children of the 90’s cohort, also known as the Avon Longitudinal Study of Parents and Children.

According to the World Health Organization cardiovascular diseases are the leading cause of death globally, killing more than 17.9 million people every year. This new research has found elevated cholesterol and dyslipidaemia in children and adolescents increases the risk of premature death by their mid-40s and heart issues such as subclinical atherosclerosis in their mid-20s.

Dr Andrew Agbaje of the University of Exeter led the study and says these findings show earlier cholesterol checks are needed. He said: “We are seeing the first evidence of the catastrophic effects of elevated cholesterol levels on the heart more than two decades before the age of 40 – which is when current health guidelines recommend cholesterol check. Waiting until the age of 40 years might result in one in five of the adult population developing preventable heart problems.

“To reduce the risk of dyslipidaemia, experts have proposed universal paediatric lipid screening including the potential adoption of an ‘adolescent cholesterol passport’ to help track the increase in cholesterol levels and initiate a timely preventive treatment in the young population. Our recent studies are now contributing stronger evidence that may facilitate a healthier heart. Therefore, public health experts, paediatricians, parents, and health policymakers should encourage early cholesterol checks, especially in the teenage years.”

In total, the data of 1,595 adolescents (955 female) was analysed. The adolescents were 17 years old at baseline and they were followed up for seven years until young adulthood at age 24. Cholesterol levels and evidence of heart damage were assessed at baseline and follow-up. Signs of heart structure damage are left ventricular hypertrophy and high relative wall thickness, whereas signs of heart function damage are left ventricular diastolic dysfunction and increased left ventricular filling pressure.

With extensive control for fat mass, muscle mass, insulin, glucose, inflammation, blood pressure, smoking status, sedentary time, physical activity, socio-economic status, and family history of cardiovascular disease, and using adults’ cut points for diagnosing heart damage, it was observed that increased low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and total cholesterol levels increased the risk of premature heart damage by 18 to 20-percent. Whereas increased triglycerides doubled and tripled the risk of early structural and functional heart damage within seven years.

These results were seen both among adolescents with normal weight and among those considered overweight or obese. Some of these results were also seen among those with normal blood pressure and those with elevated blood pressure. The findings also revealed that both males and females were affected alike. It was discovered that while increased cholesterol contributed 30-percent to the direct damage of the heart, both increased fat mass and blood pressure indirectly contributed 40-percent to heart damage. The remaining 30-percent could be explained by genetics and sedentary time.

Dr Andrew Agbaje of the University of Exeter said: “Recently we discovered that increased sedentary time from childhood contributed 70-percent of the increase in cholesterol level before mid-20s and that engaging in light physical activity can completely reverse elevated cholesterol and dyslipidaemia. Taken together, these findings suggest that being sedentary is at the root of health problems and childhood and adolescent sedentariness is a one-way ticket for cardiovascular diseases and death.”

The paper entitled Increasing lipids with risk of worsening cardiac damage in 1595 adolescents: A 7-year longitudinal and mediation study is published in Atherosclerosis.

Dr Andrew Agbaje is an award-winning physician and paediatric clinical epidemiologist. His research group (urFIT-child) is supported by research grants from Jenny and Antti Wihuri Foundation, the Finnish Cultural Foundation Central Fund, the Finnish Cultural Foundation North Savo Regional Fund, the Orion Research Foundation, the Aarne Koskelo Foundation, the Antti and Tyyne Soininen Foundation, the Paulo Foundation, the Yrjö Jahnsson Foundation, the Paavo Nurmi Foundation, the Finnish Foundation for Cardiovascular Research, Ida Montin Foundation, Kuopio University Foundation, the Foundation for Pediatric Research, and Alfred Kordelin Foundation.