Published on 6 December 2019

Researchers suggest people in their 20s should know if they have bad cholesterol in order to prevent health conditions including obesity and type 2 diabetes.

Younger people should be aware of their cholesterol levels to be aware of their potential long-term risk of developing health conditions including obesity and heart disease.

An international study team led by researchers at the University Heart and Vascular Centre Hamburg, Germany developed a risk modelling tool to predict the range of risk of having a heart attack or stroke by age 75 according to whether subjects were smokers, had high blood pressure (hypertension), type 2 diabetes or obesity.

The findings were based on the participants levels of "bad" cholesterol (non-high density lipoprotein (HDL), or non-HDL cholesterol).

For this study, recently published in The Lancet, researchers looked at 43 years of data from 398,846 people across Europe, Australia and the US, about one in three of whom were younger than 45 when the study began.

This allowed researchers to create a model to predict very long-term risks of heart attack and stroke for younger people. The model also estimated how reducing non-HDL cholesterol would lower people's risk.

Researchers found that the risk of future cardiovascular disease (CVD) by age 75 was most apparent for people under 45 if they had a high level of non-HDL cholesterol.

This could be because of the effect of having high non-HDL cholesterol over decades of life and because younger people have more time to develop CVD than older people.

Researchers concluded: "Considerable uncertainty exists about the extent to which slightly increased or apparently normal cholesterol concentrations affect lifetime cardiovascular risk and about which thresholds should be used to merit a treatment recommendation, particularly in young people. Our study extends current knowledge because it suggests that increasing concentrations of non-HDL cholesterol predict long-term cardiovascular risk, particularly in cases of modest increase at a young age."

An NHS Behind the Headlines analysis of the study said: “This complex study uses a lot of data, but the conclusions are fairly simple: high non-HDL cholesterol raises the risk of heart attack or stroke over the long term; this elevated risk starts at a younger age than previously thought; and people should have their cholesterol tested in their 20s or 30s so they can consider taking steps to lower it.

“Because of the complexity of the mathematical modelling, we cannot test the accuracy of the predictions given by the modelling tool. It is important to remember that tools like this only give an estimated average of risk, and not an actual risk for any single individual.

“There are limits to the study. As with all data collection from different sources, it is possible that some of the reporting of cardiovascular events may have been inaccurate. The studies measured cholesterol levels only once, so we do not know whether people's levels changed over time. The people in the study were mostly of European ancestry and from high-income countries in Europe, as well as the US and Australia, which means the results may not be applicable to people from other ethnic backgrounds or living in other countries.

“The study does not mean that people with high cholesterol should necessarily start taking statins in their 30s. We do not know the effects of taking statins for such a long period for people who are otherwise healthy.

“People in the UK are offered an NHS health check from age 40, which includes a cholesterol test. The first step in lowering non-HDL cholesterol is usually eating a healthier diet and doing more exercise, although some people may also be prescribed statins.”

If you are concerned about your cholesterol levels, arrange a cholesterol test at your GP surgery.

Read the report in The Lancet
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